For the ultra-wealthy, it might mean dabbling in infusions of your child’s plasma, elaborate supplement regimes, or paying tens of thousands of dollars to have your corpse pumped with an anti-freeze solution and suspended in liquid nitrogen in the hope technological advances will one day cure your ailment and bring you back to life (though while running the risk you may end up as mush).
But for those without $2m to spend each year on the quest for immortality, you might take solace in the fact there are simple, evidence-based interventions to increase your chances of staying healthier for longer (even if you must age).
What gets you moving
The director of the University of New South Wales Ageing Futures Institute, Prof Kaarin Anstey, recommends starting early and taking a holistic approach to ageing well. Firstly, building physical activity into day-to-day life is a “panacea” that helps manage chronic disease risk factors, has direct benefits for the brain and helps people stay independent in their homes.
The national guidelines lay out recommendations for physical activity and sedentary behaviour according to age, though Anstey says the activity will look different according to people’s health and abilities – whether it’s running during team sports or exercises performed sitting in a chair.
If you’re not currently meeting the guidelines, don’t give it up as a lost cause.
“There’s benefit in any activity, and it’s incremental. It’s not that you don’t get any benefit unless you’re doing say, 7,000 steps a day,” Anstey says.
“There’s all sorts of ways you can be physically active: it can be through everyday activities like climbing stairs instead of taking a lift, or lifting your groceries into the car yourself is also a form of weight resistance.”
The vice-president of the Royal Australian College of General Practitioners (RACGP), Dr Bruce Willett, adds that for older people or those struggling to get back into exercise, he recommends aiming for a level of activity that makes them “slightly breathless”.
“People ask me what’s the best exercise to do and my advice is always: ‘the one you’ll actually do’,” Willett says.
However, Anstey highlights the benefits of two strength-training sessions each week, since both muscle mass and bone density decline with age.
“For example, getting out of a chair requires a certain amount of leg strength, and people who are very inactive – they may be sick, or have other reasons they’re inactive – they lose that capacity to even stand up and be stable. Focusing on maintaining muscle strength is what’s going to really enable older people to stay physically independent and in their own homes: they will be able to walk around, lift things, and they’ve got a lower falls risk.”
Medications and managing risks
Dr Mark Morgan, a professor of general practice at Bond University and chair of the RACGP’s Expert Committee for Quality Care, says preventing frailty – a reversible syndrome that carries higher risk of injury and death – is crucial for ageing well.
“We instinctively know what frailty looks like – it’s when everything slows down. It takes longer to stand up and walk and any minor illness seems to cause a major upset.”
Alongside exercise, he says optimised nutrition and balancing medications are important.
“Medicines prescribed in middle-age often need to be changed as people get older because kidneys and liver are slower to clear them from the body. Some medicines can cause more harm than benefit as we age, so that balance needs to be achieved in discussion with the GP.”
Morgan says social connectivity is another crucial factor, and he thinks “social prescribing” will have a growing role to play in the health system.
“Often frailty happens at the same time as becoming isolated … Sometimes we need a little help to find local, affordable and engaging ways to connect. GPs, practice nurses and community centres can all help identify a surprisingly diverse range of activities and groups.”
Finding meaning, and meaningful connections
Both Anstey and Willett echoed the importance of taking loneliness seriously – given its association with a higher risk of cardiovascular disease, dementia, depression, anxiety and more.
A nationally representative survey of about 3,000 adults in 2022 revealed young people are the loneliest Australians (almost half of those aged 18 to 24 years). There were also higher rates of loneliness among people with disabilities, long-term physical health conditions, LGBTQ+ people and men.
“Speaking as a bloke, we generally don’t recognise that maintaining friendships is important for mental health and that’s important for all health,” Willett says.
Anstey also encourages thinking about what gives you a sense of purpose, and making plans around how that might change throughout different life stages.
“We find people who have better mental health and wellbeing in ageing maintain a sense of purpose. This is quite a challenge because often, particularly post-retirement, people lose a sense of purpose through work, and they have to build other forms of meaningful engagement.
“There are a lot of roles that older people take in society, post-retirement, that are incredibly valuable … mentoring, volunteering and social roles and family roles.”
A positive attitude to ageing is also protective, Anstey says. Having negative expectations about getting older has been linked to worse health and a shortened lifespan – with some studies showing people who see health problems as an expected part of ageing are less likely to engage in preventive behaviours.
“Having positive expectations about ageing has sort of been shown to be a self-fulfilling prophecy, so people who think much more positively about their own ageing tend to have better health outcomes and are happier,” Anstey says.
“I think people in my field who study ageing know, but the general community probably doesn’t, that life satisfaction actually increases with age. As we showed with the PATH report, mental health problems actually decline with age, so people feel better in themselves, they feel happier.”
Keeping diet in MIND
Anstey says the MIND diet (the Mediterranean-DASH Intervention for Neurodegenerative Delay, which incorporates the Mediterranean diet and the Dietary Approaches to Stop Hypertension) has the best evidence for reducing dementia risk, including from a study of Australians that she co-authored.
“It emphasises foods with a neuroprotective quality, so instead of being general in terms of just the number of vegetables you eat a day [as with the Mediterranean diet], it specifies leafy green vegetables every day, berries twice a week or more,” Anstey says.
The Mediterranean diet has been criticised for not being inclusive of other cultures, but Anstey says the same general principles can apply across dietary styles: minimising processed food and added sugar while eating lots of vegetables, fruit and wholegrains.
However, the current cost-of-living crisis is one example of how broader forces can make healthy behaviours difficult or even out of reach for some. “We need to have the social and economic resources … right now fish is really expensive, some fruit and veggies are really expensive, so it takes more effort and planning to be able to stick to these diets,” Anstey says.
Pills and potions
Morgan says he’s often asked about dietary supplements.
“There are no supplements that are universally recommended in Australia. A varied diet will contain all the nutrients needed unless tests have demonstrated a particular deficiency.”
Associate Prof Stephen Shumack of the Australasian College of Dermatologists says targeted diets or collagen products advertised for improving the appearance of your skin, hair and nails are unnecessary when the diet of most Australians would support their body in making and repairing collagen.
“There is virtually zero hard evidence that for somebody on a normal diet, taking collagen products orally or applying collagen-like products directly on to the skin makes any difference. If you’re putting on creams or serums which contain collagen or other molecules which are hydrophilic [they attract water molecules], you’ll often find they will cause some thickening of the skin when they’re applied, so your skin looks better temporarily.”
A not-so-sunburnt country
Sun protection tops Shumack’s list for protecting against skin cancers as well as the damage often referred to as “signs of ageing”.
“That means physical sun protection with things like hats and clothing with long sleeves, and the use of sunscreen products on a regular basis to try to minimise the amount of ultraviolet light exposure, which is associated with the development of skin cancers and precancerous lesions,” he says.
“All the signs we usually associate with ageing, [such as] ‘age’ freckles on the back of the hands and face are really changes associated with sun exposure.”
The ageing effects of sun exposure are also still present for people with darker skin, Shumack says.
The balance between protecting against sun exposure and maintaining vitamin D levels can vary according to factors such as where you live and your health.
“The current compromise is that if the UV index is less than three, you don’t need to wear sunscreen as a routine … but if you’re going to be out for any length of time, or if you have a past history of skin cancers, that’s an exception and you need to wear sunscreen all the time,” Shumack says.
Whether the index stays below three varies across cities and seasons, but Shumack notes it can still be high on cold or cloudy days.
On the decline
A low level of alcohol consumption was previously thought to lower the risk of cardiovascular disease, but this effect is strongly debated.
Regardless, Willett says there’s concern any potential health benefits would be outweighed by the increased risk of some cancers and other harms.
“They’re not recommending people abstain from alcohol completely, but they have removed all those recommendations about one glass of red wine a day.”
Willett says the “acceptable” level of alcohol consumption has declined throughout his career.
“When I first graduated medicine, around four drinks per day for a man was considered a reasonable amount, and that’s down to two for everyone, with two alcohol-free days.
“There’s also the obvious things: if you’re smoking, stop, and please don’t take up vaping – it’s not safe.”
The experts recommend these preventive checks:
Bones
“To identify who is at risk of ‘thinning of the bones’ and for those at risk a Dexa scan can be arranged by the GP,” Morgan says.
Eyes
“For anyone experiencing changes in vision, but more research is needed to work out how often and what formal eye checks should be offered to everyone. Optometrists recommend regular eye checks every one to two years,” Morgan says.
Kidneys
“Many people are at increased risk of deteriorating kidneys, particularly people with diabetes, raised blood pressure or heart disease,” Morgan says.
Heart and blood vessels
“Getting older is a risk factor for heart attacks, strokes and irregular heartbeats. It is important to have a check of blood pressure and every few years a check of cholesterol and blood sugar,” Morgan says.
Bowel
“I would highlight the over 50s doing the bowel screening tests: the evidence is they are very effective in preventing deaths from bowel cancer. Bowel cancer is the second-most-common cancer to die from, and if detected early it can make a big difference,” Willett says.
Breast, cervical and prostate
“Many cancers get more common with advancing age. There are national screening programs at different ages to look for early warnings of bowel cancer, breast cancer and cervical cancer. After balancing the pros and cons, some men choose to have a blood test every two years for prostate cancer,” Morgan says.
Sexual and reproductive health
“Talk to your doctor about the most appropriate contraception … and if people have more than one partner in a year, the recommendation is for STD screening to be done at least annually … and more frequently if they have more than three partners or have some reason for concern,” Willett says.
Skin
“If you’ve come from a family that’s had a lot of skin cancers or you’ve had a skin cancer previously then it’s important that you see your general practitioner usually, on a regular basis – whether it’s every year, or more often if you’ve had more skin cancers,” Shumack says.
“And if you come from a particular risk group – which includes people with pale skin or a medical condition associated with the development of skin cancers such as a kidney, lung or heart transplant – those people should probably be seen every year. If they’ve had a personal history of skin cancers, then it might be every six months or more frequently.”
