For many years, my colleagues and I have been fascinated by individuals like Mrs. L. R., who are so lucky to be so resilient to diseases. In 2008, we set up a research project called “Wellderly,” to study people who were at least eighty years old and had never been sick or had a chronic illness. It took almost six years for us at Scripps Research to find fourteen hundred people who fit this extreme definition of healthy aging and consented to be participants, which meant they would provide a blood sample to have all three billion letters of their genome sequenced. We hypothesized that something in their genes would account for how these folks had such exceptional health span. I don’t mean lifespan or longevity. Those measure the total number of years a person lives, whereas health span is the number of years lived in optimal health, without impairment due to disease or disability.

It turned out we were wrong. Despite the arduous and expensive task of sequencing and interpreting whole genomes several years ago, there wasn’t much in their DNA to illuminate the basis for healthy aging. Their genetic risk markers for Alzheimer’s and heart disease were only marginally smaller than they are for the rest of us. In contrast with the lack of novel genomic findings, this group of people, with an average age of eighty-four years, were obviously thinner, by almost thirty pounds, exercised more, and had more education than the general population of advanced-aged Americans. The research nurse who enrolled and interviewed the participants* found the Wellderly to be remarkably upbeat people. Many had social interactions such as bridge clubs, dance, and a circle of friends; many were community volunteers. Well into their nineties, some were so busy it was hard to get an appointment to get them enrolled. Each had their own notion for why they were so healthy, despite that some were still smoking cigarettes—up to two packs a day. While our multiyear study failed to demystify the role of our DNA in attaining the most long-lived health span, it opened our minds to other factors.

Distinct from our Wellderly group of healthy aging outliers are most people; let’s call them the Illderly. In the U.S., 60 percent of adults (all ages eighteen and older) have at least one chronic disease, and 40 percent have two or more. Among those age sixty-five and older, 80 percent have two or more chronic diseases, 23 percent have three or more, and about 7 percent have five or more. If you or someone you know has a chronic condition, it is probably one of the big four: diabetes, heart disease, cancer, or some kind of neurodegeneration. Beyond these, chronic lung and kidney disease are high on the list.

Who wouldn’t want to live a long life? Achieving longevity obsesses many of us. But living longer with chronic conditions such as Alzheimer’s, a disabling stroke, or marked frailty doesn’t seem all that ideal. What we really want is for the additional years of life to be essentially free from disease. The good news is that maximizing the years of living with intact health is becoming easier. This book is about how we can achieve our maximal health span, the shift from becoming Illderly to staying on the Wellderly path.

It can occur through two very different paths: By preventing or delaying age-related diseases or by slowing the aging process. The former is building on where we are now and for which we’ll be making considerable headway in the near term. The latter, changing aging per se, is a more formidable challenge. Mrs. L. R. escaped the major chronic diseases, which only 19 percent of over four hundred centenarians (aged 97–119 years) managed to do in the New England Centenarian Study. The majority in that study, 81 percent, developed comorbidities and were classified as either “survivors,” having a diagnosis of age-related illness before age eighty years, or “delayers,” diagnosed at age eighty and beyond. Preventing or markedly delaying age-related diseases, thereby extending health span, is what this book is (nearly all) about.

‍

Excerpted from Super Agers: An Evidence-Based Approach to Longevity, by Eric Topol, MD. Simon & Schuster, May 6, 2025

‍