(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In a series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries will be revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the first in the series.)
Renowned neurosurgeon Dr. Keith Black (chair of the department of neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles) has pioneered advances in our understanding and treatment of brain cancers and complex neurological conditions. Black is also a research scientist studying targeted drug delivery, cancer stem cells and Alzheimer's detection through retinal imaging, among many other areas. In an interview with the Milken Institute Center for the Future of Aging, Black talks about the importance of developing a test for early onset Alzheimer’s and his goal to inspire the next generation.
Dr. Keith BlackWhat is the most important thing that people should know about improving brain health? 
People need to know how important lifestyle is to sustain health. Lifestyle, diet, exercise, moderating stress, making sure you get a good eight hours of sleep when you can, making sure you keep your brain engaged particularly in novel activities — all of these matter. You have to remember the brain is a living organism very much like a muscle — the more you use it, the stronger it becomes.
We need to treat our brains better. For example, try to avoid excessive alcohol and make sure that you screen yourself for diseases like diabetes and hypertension that can be devastating to the brain.
What will be the benefits of having a reliable test for early onset Alzheimer’s?
I think there’s a huge misconception that if you get Alzheimer’s or if you’re going to get Alzheimer’s, there’s nothing that you can do about it. And I think the science shows that that perception is incorrect.
We know two things now that address your question. The first is that Alzheimer’s starts about two decades before a person develops symptoms. During that period of 20 years, you’re losing brain cells, and you’re losing brain connectivity. If you can detect the disease at the very start, particularly before you lose enough brain cells to become symptomatic, we may have the ability to stop the process or at least slow it down and prevent an individual from becoming symptomatic.
If people are developing Alzheimer’s in their 50s and 60s, they are going to become symptomatic in their 70s and 80s. If you can slow the overall process and have people become symptomatic in their late 90s or 100s, you have the ability to essentially prevent the disease from being symptomatic in most of our lifetimes. That’s really the major reason to move towards early detection, because preventing brain loss is a lot easier than restoring brain cells once they’ve died.
The other reason people should be interested is that even though we don’t have a pill that can stop the progression, we know that Alzheimer’s also has a lifestyle component. The scientific evidence shows that lifestyle habits such as a Mediterranean diet, exercise, sleep, meditation and other types of mindfulness modify stress levels. We’re seeing that potentially even micronutrients like the omega-3 fish oils may be very important in slowing the progression of Alzheimer’s disease.
What’s your take on Pfizer ending research to find new drugs aimed at treating Alzheimer's and Parkinson’s diseases? How do you think it will impact ongoing research?
I think a lot of the trials that have failed for Alzheimer’s disease, including the Pfizer trial, could’ve been better designed and better developed. I think we have a lot to learn from the failure of those trials.
For example, how do we get the drugs into the brain more effectively? How can we better select the right population of patients to treat? I think addressing those potential reasons for the failures of those drugs will lead to successful therapies and hopefully successful approvals.


The Best Way to Improve Brain Health

 (Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the second in the series. The first was The Best Way to Improve Brain Health with Dr. Keith Black.)
When it comes to being an advocate for the rights of domestic workers, many of whom care for their employers' aging relatives, MacArthur Fellow and Next Avenue Influencer on Aging Ai-jen Poo is on the front line. The director of the National Domestic Workers Alliance and co-director of Caring Across Generations has made it her mission to empower and organize domestic workers, protect their rights and improve their working conditions. In an interview with the Milken Institute Center for the Future of Aging, Poo talks about the impact of population aging on the caregiving workforce and how the future of home health care depends on quality jobs.
Milken Institute Center for the Future of Aging: In the United States, 10,000 boomers turn 65 every day. How do you think this population boom will affect the caregiving workforce?
Ai-jen PooAi-jen Poo: With boomers aging and people living longer than we ever imagined possible, there’s been a dramatic growth in the older population and, along with it, the need for care, particularly home-based care.
This generation of older people wants to age in their communities, connected to friends and family, rather than an institution. What that means is that the direct care workforce will continue to grow, and particularly the home-care workforce.
At the moment, these are poverty-wage jobs. With a median annual income of $13,000 per year, the workers, whom we’re counting on to help us care for our families, can hardly care for their own doing this work. We will need to invest in this workforce in a new way if we are to have a strong workforce to help us live well in the future.
It also means that more families will be managing care, and we will need to support our family caregivers better. At the moment, caregivers — whether professional or family — are hardly in our consciousness, let alone in our policy solutions.
Home care is one of the fastest growing occupations in the nation. Do you think it will start keeping pace with the need due to the population boom? 
The growth of home care as an occupation won’t keep pace with the need unless we improve the quality of jobs. At the moment, because we have so undervalued the work, we often lose our best caregivers to jobs in fast food or retail. At the end of the day, working people need to pay the bills and take care of their families, and at the moment, it’s very hard to do that doing home care.
The rates of turnover reflect the instability of the existing workforce, despite its rapid growth. We can change all of that, and states like Washington have demonstrated that it is possible. The state of Washington, thanks to the efforts of the home-care union and forward-thinking elected officials, has consistently raised wages and offered high-quality training for the workforce. As a result, Washington is qualitatively much better prepared for the elder boom than most other states.
For years, you have been organizing and advocating on behalf of our nation’s domestic and home-care workers. What lessons have you learned?
I’ve learned that oftentimes it’s the people you least expect who end up inspiring others the most. I have seen domestic workers and home-care workers capture the imaginations of the most cynical people in the nation when they describe their experiences and their activism — and, most importantly, their victories. It was everyday women with difficult jobs, families to care for, and bills to pay (and all the people they inspired) who brought two million home-care workers under minimum wage and overtime protections. Everyday women can, and have, made history and will continue to do so.
You have stated that we can build a strong care workforce by ensuring that professional caregivers receive livable wages and benefits. Do you think we are close to achieving this goal?
We have a culture that has never adequately valued this work as real work…  While I think we made progress when the Department of Labor finally changed Fair Labor Standards Act regulations to include home-care workers in minimum wage and overtime protections, I think we are still a long way from livable wages and good jobs.
States like Maine, which will be deciding on the “Home Care for All” citizen’s initiative in November, or Washington State, which is working on a “Long-term Care Trust Act,” are on the cutting edge. Those states could dramatically improve the quality of work and quality of services available to us.
Once those measures succeed, which could happen soon, I will say we are on our way!


Building a Strong Home Care Workforce

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the last story in the series.) 
Director of the Longevity Genes Project at the Albert Einstein College of Medicine, Dr. Nir Barzilai has discovered several longevity genes in humans that appear to protect centenarians against major age-related diseases. Barzilai is also co-founder of CohBar, a biotech company developing mitochondria-based therapeutics to treat diseases associated with aging. In an interview with the Milken Institute Center for the Future of Aging, Barzilai explains why some people have longevity genes and the challenges in drug design for age-related diseases:
Milken Institute Center for the Future of Aging: In your research, you discovered that you don’t have longevity genes in your family. How did this influence how you approach your work?
Dr. Nir BarzilaiDr. Nir Barzilai: I want to do it as fast as possible. I’m more desperate. That’s how it affects me.
My wife, on the other hand, comes from a family where her great-grandfather died at age 102. He was born at the end of 19th century, where very few people reached the age of 100 — maybe one in a million. His daughter also lived to be the age of 102. My wife’s father is now 87, but if you saw him, you would think he’s more like 70. He plays singles tennis twice a week.
My wife’s side of the family is clearly okay, but my side of the family is not okay.
What are some recent findings of the Longevity Genes Project?
We discovered that longevity genes affect the growth hormone axis. So, in nature, smaller animals live longer — small dogs live longer than the big dogs, ponies live longer than thoroughbreds. If you conduct an experiment in a lab, and you have dwarf versions of animals by accident or by design, they all live longer and live healthier.
We found that over 50 percent of centenarians have some gene in the growth hormone pathways that are affected. This might be the strongest link to longevity we’ve seen.
We've had a paper recently accepted to be published in Nature Communication that illustrates how we could block the growth hormone with antibodies in mice so that they live 15 percent longer.
Why do some people have the longevity genes and others don’t? And how does it affect our aging process?
Well, I think it’s complex, but I’ll answer it as simply as possible. What’s important to evolution is that you reproduce and pass your genes to the next generation. That happens when you’re young. Now, whether you die the day after you have your kids or you live 100 years, it doesn’t matter, because reproduction has already happened. What happens after reproduction is something that evolution cannot really take care of very well.
Some people age faster, and some people age slower.
The important thing is, it’s an opportunity, because the current maximum lifespan of humans is somewhere around 115 years. There are probably hundreds of people during the last millennium or so who reached the age of 115. And, on average, we die at an age less than 80. So,  we have 35 years with low-hanging fruit where we could start working on our maximal capacity and extending our health span.
How do you respond to scientists who only focus on lifespan?
Some of the models we use can extend lifespan without healthspan. There are nematodes [roundworms] that can live longer, but they don’t move for most of the time — almost in a vegetative state.
I have to say that in humans, it’s really not like that. In humans, lifespan and healthspan are connected. We have to make sure that our treatment isn’t going to debilitate people, but instead will make them live longer and healthier.
You are the recipient of many accolades and awards, including being named the Beeson Fellow for Aging Research. What do you hope to achieve next?
I’m helping to fund more early-stage bioscience and biotech companies, because we should start targeting aging and start developing the drugs now, so that we’re ready when the FDA [Food and Drug Administration] is prepared to approve them. We have to move fast.
I think that, at the very least, in about five years, most elderly people will be on metformin, which is a pill capable of preventing certain components of aging. Add two or three years to that, and there will be better drugs and combinations of drugs that will allow us to live much healthier for longer.


Why Some People Have Longevity Genes and Others Don't

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the third in the series.) 
Dr. Regina Benjamin served as the 18th Surgeon General of the United States, appointed by President Barack Obama in 2009. As the “nation’s doctor,” she served a four-year term focusing on health disparities, disease prevention and children’s health. In an interview with the Milken Institute Center for the Future of Aging, Benjamin — founder and CEO of BayouClinic — talks about how a sense of purpose leads to longer, healthier lives and the importance of making disease prevention a priority.
Milken Institute Center for the Future of Aging: Why did you launch Bayou Clinic? What is the mission and your vision for its impact?
Dr. Regina BenjaminDr. Regina Benjamin: I went to medical school, I enrolled in what was called The National Health Service Corps. They paid your tuition to medical school, and you had to pay your time back in an underserved community. I’m from a town close to that, and I wanted to get as close to home as I could, so I ended up in Bayou La Batre in medical school. I liked the area and wanted to open a clinic, because there were so many people that weren’t being served. I just thought it was important to bring a little bit of care to this community.
My mission is to deliver health care with dignity to the community. That’s my mission, has always been from Day 1. Anybody and everybody that walks in the door, regardless of their ability to pay.
How does your clinic address disease prevention?
My whole professional focus, both in the clinic and as Surgeon General, has always been on prevention, so at the clinic we stress prevention very strongly. We do the things that we should do in medicine anyway. We try to keep people’s blood pressure under control, teach them how to eat right, exercise. We have a lot of classes that also engage the community.
So, when we went through a lot of challenges like Hurricane Katrina and rebuilt our clinic, we built a walking track around the perimeter of the clinic, so the entire community, if they want to come, can walk. We have people walking in groups.
Do you think any significant progress has been made to reduce the burden of obesity?
Yes, I do. When I first became Surgeon General, at my initial press conference —  Mrs. Obama, the First Lady, was there with the Secretary of Health — we told the press that we were going to introduce something to address obesity. Six weeks later, what we introduced was the First Lady’s Let’s Move Initiative. By the time I left office in 2013, we saw the percentage of young people and children with obesity start to be on the decline.
How can we make disease prevention a priority?
Prevention is my mantra. The more we can prevent the better. We’ll be healthier as a community and healthier as a nation, but we also need to recognize that there are other things that contribute to health, like clean air and clean water and where we live.
Focusing on those things also can add to our disease prevention — priorities we need to be thinking of as a nation. We need to think about how everything affects our health, not just whether you went to the doctor and whether you got a blood pressure pill, but is there a place to walk, is there a place for your kids to play.
How can having a sense of purpose advance efforts to live longer, healthier lives?
Scientific research shows us that having a purpose is one of the hallmarks of what we call Blue Zones, where people live longer, healthier lives around the world — one of the things that the people have in common is that they have a sense of purpose. Everybody should want to feel like they’re making a difference somewhere in their lives.
If you’ve got a purpose when you get up in the morning, a belief in something that you want to do or something that keeps you going, you’re going to be healthier because of it, you’re going to feel better, you’re going to want to do, you’re going to want to be healthy.


Making Disease Prevention a Higher National Priority

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the 12th in the series.) 
Since 2010, Pulitzer Prize winner Ellen Goodman has been a leading voice in the conversation about end-of-life care. She is the founder and director of The Conversation Project, a public engagement initiative whose mission is to have every person’s wishes for end-of-life be care expressed and respected. She is also a New York Times bestselling author and former syndicated columnist for The Boston Globe and The Washington Post Writers’ Group. In an interview with the Milken Institute Center for the Future of Aging, Goodman reflects on the importance of having an advance directive and how our health-care system can reduce unnecessary and unhelpful interventions at the end of life.
Ellen GoodmanWhat led you to launch The Conversation Project?
The Conversation Project came about in the aftermath of my mother’s death. My mom and I were very close, in fact, I’d say we used to talk about everything, except how she wanted to live at the end of her life —the care she wanted and the care she didn’t want.
Toward the end, she had dementia and could no longer make decisions for herself. I mean, she couldn’t decide what she wanted to have for lunch, let alone what she wanted to have for health care.
I was left facing a cascading number of decisions for which I was really quite unprepared, blindsided and pretty shocked. I realized then that I wished that I had her voice in my ear while I was making these decisions, and I wished that we’d talked about what mattered to her.
I started talking with other people — I’m a journalist by training — and everybody had a similar story. It was so close to the surface that all you had to do was tell your story, and then, bingo, out would come their story.
And the difference between a good death and a hard death depended on whether they had had the conversation with the people they loved. So, we began to think about that and, as a long-time student of social change, I realized that change happens when people tell each other their stories.
When do you think people should start talking about how they want to live at the end of life?
They should start thinking about that as early as possible, starting when they’re 18 and technically adults. People don’t realize that once they are adults, or once their children are adults, their parents are no longer necessarily their health-care proxies.
People need to think about how the world is full of uncertainties and accidents much earlier than they do.
How can our health-care system reduce unhelpful interventions at the end of life?
We need to put people and their wishes at the center of decision-making, so that it isn’t doctors who’re making these decisions on their own. Patients should be making the choices along with the people they love.
We know that a lot of people are not dying in the way that they would choose. And we know that that leads to depression, guilt, and uncertainty among their survivors — uncertainty about whether they’ve done the right thing. The only way to make it easier for survivors, our families and all the other people, is to share with them what we really want.
How important is having an advance directive?
Whether you choose to write it down or pick a health-care proxy and tell that person how you want to live at the end of your life, the important thing is to choose somebody who can speak for you when you can’t speak for yourself.
That person needs to know what you want — not what they think you want, but what in fact you would want in any circumstance.
You need to discuss the care you want, where you want to be at the end of your life, who you want to be with, and, of course, the medical treatment you want and don’t want.
Why do you think people are not comfortable talking about death? 
I don’t think that’s a big mystery. It’s the big D word.
There are all types of literature, religious beliefs and so forth that revolve around our fear of death. At the same time, there’s a wonderful line in the online satirical magazine The Onion that said, “Death Rates Hold Steady At 100 Percent.” So, we know that everybody is going to die, but it’s like the Woody Allen line, “You think you might be the exception.”
Or, there are some people who think that if you talk about death, you bring it into the room. We think quite the opposite. We know from experience that even though people are reluctant to start the conversation, after they do, they describe it as one of the richest and most intimate conversations they have ever had, and they’re filled with relief and comfort.


Changing the Conversation About End of Life

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the seventh in the series.) 
Elizabeth Blackburn, president emerita of the Salk Institute for Biological Studies, is one of only 12 women to have won a Nobel Prize in physiology or medicine. She was honored for her co-discovery of telomerase, the enzyme that replenishes the telomere, an area of the chromosome related to the process of aging. In this interview with the Milken Institute Center for the Future of Aging, Blackburn —the Next Avenue Influencer of the Year in 2017 — emphasizes the importance of maintaining healthy habits, why telomeres are essential for healthier lives and how stress can be a positive experience.
Milken Institute Center for the Future of Aging: Can you explain what a telomere is and its role in our living longer, healthier lives?
Elizabeth BlackburnElizabeth Blackburn: Telomeres are like the protective caps on the ends of shoelaces. They prevent the ends of a shoelace — a metaphor for a chromosome — from fraying, which chromosomes often do as cells divide. Telomeres absorb the wear and tear themselves, and so each time the cell divides, these telomeres often become a little shorter. When they get too short, they signal the cell to die.
Now, we know that telomeres dynamically protect chromosome ends, so our genes stay intact and our cells continue to work well. We have come to understand that if that protection is compromised, it prevents our cells from thriving and growing properly. Unless replenished — by a special molecular mechanism called telomerase that we also discovered in my lab — the tendency of telomeres in humans is to become compromised over time.
Indeed, in humans, telomeres wear down with age and through many other influences. More and more, we understand the nuances of the balance between these opposing forces of telomere attrition and replenishment. The balance — or lack of it — affects cellular health and the entire body’s propensity for various diseases that increasingly plague humans as we age.
What’s the function of telomerase? How is it linked to healthy living?
Telomerase is the enzyme that replenishes telomeres. In humans, we now know that a proper “Goldilocks” balance of telomerase is needed. Too much telomerase action in some of our cells can tip the balance over into real risks for cancers.
So, it is imperative not to be tempted to stray into misguided over-use of, for example, unproven substances that claim to increase telomere maintenance. In contrast, we have learned — by directly studying humans — what works safely for telomere maintenance.
Luckily, there is a great deal that we individually and as a society can do to improve telomere health safely: getting enough sleep and exercise, finding and learning ways to cope with chronic psychological stressors, Mediterranean-diet-type eating habits, various forms of social improvements, unpolluted environments — they all add up.
These good influences on telomere maintenance are things that are actionable right now and do not increase cancer risks.
How can we make disease prevention a priority?
We can use our ever-increasing knowledge about the biology that underlies the slow development of these diseases — prominently, heart disease, diabetes, cancers, neurodegeneration and depression. Such diseases and conditions do not happen overnight, immediately before they are clinically diagnosed. Rather, they can take months and usually years to develop and manifest.
Thus, there are many points at which their progression can be potentially intercepted or even reversed. We can use the knowledge we have about aspects of disease biology — such as the contributions made by telomere attrition in our cells (which is only one part of the whole story) — to decide what will actually improve health and mitigate disease risks.
As an example, measuring how well telomere function is maintained can provide one objective way of assessing the effectiveness of what we can do in our lives to promote health and determine which societal policies have health impacts and which clinical and pharmacological interventions work best.
Since behavior change is hard, how can we get people, even in small doses, to see the importance of not ignoring healthy habits?
Sometimes, having an understanding of what goes on in our bodies can help.
People have repeatedly mentioned to me and other researchers that having a mental image of their telomeres wearing down actually helps them to be motivated to adopt or keep up healthier actions. (I know this is true for me, personally!) This is a fruitful area to explore for developing optimal strategies that help people expand their health-giving habits.
How can stress be seen as a positive challenge? Can you explain?
My colleague and co-author of our book, Elissa Epel, explains this research in the book.
Essentially, it means when you think: “I can take this on.” It means you can learn to get yourself into the habit of reframing your responses to stressful things as challenges, rather than as simply threats over which you will have no control.
It is not denying or minimizing the reality of the stresses, but presenting them to yourself in a different way, so that you can respond in ways that, interestingly, have been associated with better telomere maintenance (among other benefits).


The Habits That Can Help You Live Longer

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the 13th in the series.) 
Professor André Fenton of the Center for Neural Science at New York University and Neuroscience Institute, NYU Langone Medical Center, is a neurobiologist studying how brains store experiences as memories. In particular, he looks at how self-expression works with our memory to give us only the information that matters. In an interview with the Milken Institute Center for the Future of Aging, Fenton explains how his work is increasing our understanding of the aging brain and the role that protein kinase M zeta (PKMzeta), plays in maintaining long-term memory.
Milken Institute Center for the Future of Aging: Can you explain why protein kinase M zeta (PKMzeta) is so essential for long-term memory?
Andre FentonAndre Fenton: We remember information for long periods of time. There has to be a physical, biological way this happens.
We know that for memories to persist, proteins have to be made. We know that proteins are encoded by genes and by activating specific genes, specific proteins are made in individual cells. The problem is that most proteins only last a few days before they are damaged and destroyed by the chemical environment inside cells.
How is it possible to build memory, something delicate and precise that persists for years, when the building materials only exist for days? If the cell replenishes destroyed proteins that are crucial for storing memory, it is not clear how the replacement proteins know where in the cell to go — each cell has several thousand synapses, but only tens to hundreds of them are the storage sites for a particular memory.
This is where PKMzeta comes in. It is an unusual protein, with properties that can solve these problems.
PKMzeta is a kinase, which means it phosphorylates (i.e., works by modifying) other proteins, by turning them on to perform a specific cellular function. PKMzeta is unusual because each PKMzeta molecule can “turn on” (phosphorylate) other PKMzeta molecules, perhaps protecting them from being degraded. Once cells produce PKMzeta molecules, they are automatically turned on. That means a cluster of PKMzeta molecules can keep themselves turned on perpetually.
PKMzeta, when newly synthetized by the cell, can diffuse throughout the cell, but the molecules are most likely to be protected from degradation if they diffuse to an existing cluster of PKMzeta molecules, where the newly synthesized PKMzeta can replenish PKMzeta molecules that were destroyed and thereby perpetuate the cluster.
This “persistent kinase” property is a mechanism for making a molecular switch that, once it is turned on, can stay turned on indefinitely. PKMzeta seems to work this way, which is a plausible biological mechanism of memory persistence.
What does your work tell us about the aging brain? 

I work on two related, but distinct, problems that are relevant to understanding the aging brain. One is the biological mechanism of memory persistence; the other is the biological mechanism for how information is read out of a particular set of neural circuits in the hippocampus and related regions.
Memory function requires not only a way to store information but also a way to read out that information. The reading problem is an electrophysiological problem, but it is founded in how electrical neural activity is generated and transferred across synapses from one set of neurons to another.
The aging brain can show abnormalities both in how synapses function —unfortunately synapses are lost with aging — as well as in how electrical activity propagates through the networks of neurons in the hippocampus and the connected areas. When we better understand the biological basis of memory, we will better understand how this biology is altered in aging.
Since the PKMzeta molecule plays a crucial role in memory retention, how do you see this knowledge transforming future research? 

Once we understand the biology of memory formation and persistence, we will be better able to understand how the mechanisms of memory formation and persistence are affected by neurodegenerative diseases. We can design optimal ways of protecting against cognitive impairment or even attenuate and restore brain function from diseases that affect neurobiology.
Imagine with Alzheimer’s disease, for example, that we knew PKMzeta is crucial for memory persistence and we also knew that the neurofibrillary tangles pathology in AD acted to sequester PKMzeta, hijacking it from getting to synapses where it is needed for storing memory and directing the flow of neural information. If that was the case, we could design novel AD treatments like drugs that prevent PKMzeta binding and sequestration to the neurofibrillary tangles. We just don’t know enough yet.
How can new technologies advance research on memory formation?
Most advances in science are driven by technological advances, such as the ability now to better measure and manipulate biological objects of interest. Memory research is now limited by the widespread unavailability of technologies to measure the strength of many individual synapses, or the voltage across the membrane of a compartment of a neuron, as with a synapse. Technologies that allow specific genetically- or functionally-defined cell types to be marked and manipulated are helping advance memory research.
Technologies to selectively interfere with and/or selectively activate PKMzeta and other molecules at synapses are also helping advance the field, along with technologies to visualize where and how long PKMzeta molecules reside in sub-cellular locations.
Finally, technologies that allow recording and manipulating the electrical activity of many individual neurons will also be invaluable.


The Key to Forming Long-Term Memories

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the sixth in the series.) 
Trish Lopez founded Teeniors™, a multi-award-winning startup that includes tech-savvy teens and young adults who help older adults learn technology through one-on-one, personalized coaching. In an interview with the Milken Institute Center for the Future of Aging, Lopez, who is also Teeniors’ CEO, explains the impact of intergenerational connections and how companies can change the future of aging.
Why did you start Teeniors? 
The idea that became Teeniors came to mind because of the way I see older adults marginalized and somewhat alienated in our society. My mom, Lillian is an example — she’s 78 and loves technology. She likes reading CNN on her smartphone, checking out Facebook photos of our family. She also hates technology.
There are several times a month when my brothers or I get a phone call. She loses her password, loses documents and has trouble understanding some technologies; the reality is, we can’t always be there to help. It turns out, of course, that we’re not alone in this problem.
There are millions of Lillians out there. For these people, and those of us who love them, we created Teeniors.
What surprising lessons have you learned regarding intergenerational connections?
The first surprising lesson is how this program benefits the kids and young adults just as much as it benefits the seniors. We hear quite a bit from the teens who work with their parents about the significant impact it’s had on their own lives, mostly in the way of developing higher self-esteem and self-confidence, especially for those who are shy, introverted or socially awkward.
We’ve also learned how ignorant our society is of the way we isolate and disregard people as they age. The discrimination older people face is horrible; the isolation and loneliness that aging people experience cause profound emotional and health issues. On the other end of the spectrum, many young people who crave human connection can find friendship and great wisdom from older adults.
Older adults who are happier and healthier help our society becoming happier and healthier. They are more valuable and engaged in entering the workforce, volunteering and taking care of young relatives or others.
The greater diversity in our society, the better it is for all of our communities. That diversity does not just come in the way of race or gender; it comes in including people of different ages, cultures, skill sets and special needs. The more we can see this diversity in our communities and recognize its value, the better off we will be.
Trish Lopez, founder and CEO of TeeniorsApart from adapting to the digital world, what other benefits do older adults receive from intergenerational connection?
There’s a human connection element for sure. One example happened between Terri, an older adult, seeking help during one of our first ever group coaching events, and a new teenior, Katie.
Terri wanted to learn how to access her boarding passes online. When she had finished her session with Katie, I walked up to do my usual customer feedback review. Terri burst into tears and said: “For someone who’s alone, who has no young people in her life, you all have given me hope. Someone will help us and not yell at us? You welcomed me the moment I walked in. You didn’t make me feel stupid or condescended to. I hope you realize the impact of what you’re doing here for people like me.”
That conversation, both for Katie and me, was so meaningful that it was one of the things that inspired me to keep going with this project for the rest of that first year. I somehow knew exactly how she felt.
In our youth-obsessed culture, is it possible for intergenerational connections to have a large and lasting impact? 
Yes. We’ve seen it. We’ve had clients and coaches who’ve become friends and stayed to talk to each other past their “work time.” And every single coach we’ve had, and nearly every client we’ve had (over 1,000), has provided us feedback about the impact this has had on their lives.
How can companies work to challenge conventional wisdom and change the future of aging?
Simply ignore the conventional wisdom. If what is conventional wisdom to you about older adults is the same that was conventional wisdom to me (like the older you get, the less you “get it”), ignore it. Change that conventional wisdom by acting as though that boundary, that limit, that generalization does not exist.
Create things for human beings, not for age groups.
What do young people gain from working with the older adults? Moreover, how do the older adults contribute in their own ways? 
Young people love this work. That’s what we have seen. Why do they love it? Because they immediately go from being underestimated, to the most valued person in the room.
They’re respected for their knowledge, and they’re appreciated for their help. One example of that appreciation is the Terri story, and we have dozens more like that.
What do you say to those who are not aware of the power of intergenerational connections?
My response would be similar to any other question of a lack of awareness about anything. Whether it’s the power of intergenerational connections, diversity in who you spend time with, open-mindedness in thought — it’s all a matter of educating yourself about things you don’t know about.
If you choose to do that, you can live such a richer, fuller life.


The Benefits of Connecting With Young People

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the fifth  in the series.) 
New York Times bestselling author Dan Buettner has traveled the globe visiting the places in the world where higher percentages of people enjoy long, full lives, areas dubbed “Blue Zones.” The National Geographic Fellow founded Blue Zones LLC to help people live longer, healthier and happier lives by improving their environments. In an interview with the Milken Institute Center for the Future of Aging, Buettner discusses how American cities can become places that older adults choose to reside, the importance of positive outlook and how we do have choices in how we age.
Milken Institute Center for the Future of Aging: What led you to start researching longevity hot spots? Have you found any common themes among them?
It all started in the spring of 2000 when I was leading a series of educational projects for National Geographic called “Quests,” in which a team of scientists investigated some of Earth’s great puzzles. I had heard about Okinawans’ unusual longevity and thought it would be a great quest to investigate what their secrets to good health and long life were. We spent 10 days studying, exploring and summing up what we found.
Five years later, I returned to Okinawa with a new team. I’d just written a cover story for National Geographic about the “Secrets of Long Life,” which profiled three areas of the world with concentrations of some of the world’s longest-lived people — areas we dubbed “Blue Zones.” I was determined to delve deeper into the lifestyle of Okinawa.
During these explorations we were always thinking, how can we bring these teachings back to our communities? This is how the Blue Zones project was born.
We decided that we could take the nine evidence-based common denominators that we found in all the Blue Zones and implement them in communities across the United States. Our goal was to make small adjustments to make the healthy choice the easy choice for people in their communities.
What’s your take on how American cities can become places that older adults choose to reside?
Dan Buettner, author of 'Blue Zones'Studies show that social isolation and loneliness kill. It’s important that older adults have easy access to transportation or are able to walk to where they’d like to go.
People don’t want to be put somewhere and forgotten. They want to pursue their hobbies, see friends and have a strong purpose.
How can communities play a role in embracing an active and healthy lifestyle?
It’s most important that we curate environments that encourage healthy lifestyles and diets. If the healthy choice is the easy choice in our day-to-day lives, we will take that route over the unhealthy option.
Living in a place that promotes walking (being able to walk to work, school, the grocery store and parks) is an extremely important aspect. Also, having access to fruits and vegetables is something many people take for granted around the country, but some locations are food deserts, and even if you want to eat healthy, you can’t.
How does the Blue Zones project encourage a sense of purpose? 
We always encourage people of every age to volunteer and keep purpose in their day.
One of our favorite centenarians in Loma Linda, California, was Marge Jetton, who, even at the age of 105, was volunteering at over seven organizations around her community.
Also, an extremely important aspect of a centenarian’s life is to connect with friends and neighbors. The world’s longest-lived people chose — or were born into — social circles that supported healthy behaviors. Okinawans created “moais” — groups of five friends that committed to each other for life.
It is also important to surround yourself with the right people who share your values of health. . So, the social networks of long-lived people favorably shape their health behaviors. This is good for up to 10 additional healthy years of your life.
Does culture affect happiness? And are certain cultures more inclined to be happy? 
As Winston Churchill once said, shape your environment, and it will shape you. I don’t believe in happy cultures — they're a myth.
In places around the world that have produced the happiest populations, you always see the same pattern: 50 to 100 years ago, enlightened leaders shifted their focus away from economic development to quality of life.
They focused on public health and not the sick care we have in the U.S. They enacted policies to favor equality, trust, and tolerance — all three of which are more highly correlated to life satisfaction in rich countries than incremental GDP growth.
They made sure every kid could read — that girls and women were educated. This produced mothers who had fewer children and those children were healthier, better educated and grew up to be more productive adults who made better voting decisions. Hence, an upward ratcheting in well-being.
How would you respond to those who say we do not have a choice in how we age? 
You can choose what to eat, who your friends are and what you do with your free time. All three can have profound impacts on your life expectancy.
If you choose vegetarian friends whose idea of recreation is tennis or biking and like to engage in meaningful conversation, you’ll have a much better outcome than sitting around with friends who watch TV and eat hot dogs. The choice is yours.


How to Make U.S. Cities Blue Zones for Healthy Longevity

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the eighth in the series.) 
Arianna Huffington, founder and CEO of Thrive Global and founder of The Huffington Post, knows what it takes to reinvent herself. Lately, she has taken on a new mission: ending the worldwide culture of stress and burnout. In an interview with the Milken Institute Center for the Future of Aging, Huffington explains the role of restorative sleep in reducing stress, how to take control of our tech habits and why sleep becomes more important as we age.
The Milken Institute Center for the Future of Aging: Why did you decide to launch Thrive Global? What is its mission and your vision for its impact?
Arianna HuffingtonArianna Huffington: The seeds of Thrive Global go back to 2007 when I collapsed from exhaustion. After that episode, I became more and more passionate about the connection between well-being and productivity. And that led me to write my two books, Thrive and The Sleep Revolution.
As I traveled on my book tours, discussing the issues of stress, burnout and sleep deprivation, I saw how deeply people want to change their lives. So, I wanted to go beyond just speaking out and raising awareness — I felt the need to turn this passion into something real and tangible that would help people change their daily lives.
It was a call to action I just couldn’t ignore — and so I founded Thrive Global.
Our mission is to end the stress and burnout epidemic by offering companies and individuals sustainable, science-based solutions to enhance well-being, performance, and purpose and create a healthier relationship with technology.
There is a pervasive belief that burnout is the price we must pay for success. As we know from recent scientific findings, this is a delusion. When we prioritize our well-being, our decision-making, creativity and productivity improve dramatically. Thrive Global is committed to accelerating the culture shift that allows people to reclaim their lives and move from merely surviving to thriving.
Does sleep become more important as we age?
Sleep is important at every age, but the particular benefits of sleep — and dangers of sleep deprivation — can change as we age. For example, recent science has shown that sleep is connected to Alzheimer’s disease.
Why do you think so little attention is given to sleep and other approaches to disease prevention and wellness? How can we change that?
Our society’s attitude toward sleep actually goes back to the Industrial Revolution, when time spent sleeping began to be seen as just more time to be colonized and monetized. And that misguided idea still lingers today.
But the last few decades have seen a mountain of science showing how deeply connected sleep is to our health, well-being and productivity. So, the culture shift is underway, but because there is so much at stake, we need to accelerate it.
Can you explain how sleep deprivation impacts chronic diseases as well as weight gain? 
There have been many studies showing how sleep deprivation compromises our immune system, which makes it harder both to stave off disease and to recover from it. And with weight, when we get more sleep, we produce less of a hormone called ghrelin — the ”hunger hormone” — which increases appetite.
What’s your take on sleeping pills?
There are, of course, times in our lives — a traumatic experience, the death of a loved one — when we might need some temporary help getting to sleep. But it’s important to make a distinction between turning to sleep aids at such moments and turning to them as an everyday cure for sleeplessness.
Sleep difficulties can turn into serious medical problems. For the vast majority of us, however, sleep difficulties are a lifestyle problem, and that should be the solution, instead of pills that come with a long list of side effects.
What advice can you share about how to take control of our tech habits?
Of course, technology allows us to do amazing things, but it’s also accelerated the pace of our lives beyond our capacity to keep up. An unhealthy relationship with technology can fuel stress and burnout.
It’s important to be deliberate about making time to unplug and recharge. And you can start at the beginning and end of the day. Our phones are repositories of everything we need to put away to allow us to sleep — our to-do lists, our inboxes, the demands of the world. So not lying with your phone before bed and, instead, putting it to bed outside your bedroom as a regular part of your bedtime ritual makes you more likely to wake up as fully charged as your phone.
In the morning, taking a few minutes to breathe, meditate, or just set your intention for the day — not just what you want to get done but what kind of day you want to have — can stay with you for the rest of the day.
Resisting your phone and creating these spaces at the beginning and end of your day also reinforces your sense of being in control of your relationship with technology.
How can people prevent stress from becoming cumulative? Also, what’s the role of restorative sleep in reducing stress?
Restorative sleep is hugely important in reducing stress. And it is part of what we need to do to prevent stress from being cumulative.
But it’s not just about what happens at night — we also need to schedule time, even a minute or two, to unplug and recharge regularly throughout the day. That’s what gives us the resilience to manage situations that would otherwise lead to cumulative stress.


Ending the Stress and Burnout Epidemic

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the 11th in the series.) 
Harvard Medical School professor Dr. Sharon K. Inouye is one of the world leaders in geriatrics research and innovation. Inouye, director of the Aging Brain Center at the Institute for Aging Research, Hebrew Senior Life in Boston, founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients. In an interview with the Milken Institute Center for the Future of Aging, she talks about the role delirium plays in the development of Alzheimer’s and other dementias, and simple, effective ways to prevent it from occurring.
Milken Institute Center for the Future of Aging: Can you explain how delirium affects the aging brain? 
Dr. Sharon K. InouyeDr. Sharon K. Inouye: Our studies have shown that delirium — an acute confusional state that develops in the face of acute illness, hospitalization, surgery, anesthesia and medications — can lead to long-term cognitive decline and, potentially, dementia. The exact mechanisms of how delirium affects the aging brain remain elusive, and this is an area of active research for my group.
Along with a team of superb interdisciplinary investigators, we have just been awarded a $13.6 million grant from the National Institute on Aging to examine the pathophysiologic basis and biomarkers for delirium. Using electroencephalography and functional imaging, we will be examining its relationship to Alzheimer’s disease biomarkers, inflammatory biomarkers, neuroimaging changes and markers of brain plasticity.
This study will be an important advance for the field, allowing us to identify mechanisms that we hope will lead to effective treatment strategies in the future.
What are the most important parts of building brain health? Are we missing key information about improving brain health? 
The most important parts of building brain health are: exercise, healthy diet, adequate sleep, avoiding tobacco and excessive alcohol, reducing obesity and treating high blood pressure and diabetes. However, not enough attention is being paid to protecting the brain during illness, hospitalization, and surgery — times when the aging brain is extremely vulnerable to damage that may not be reversible.
Much can be done to prevent delirium in these settings — for instance, providing early mobility and exercise, reducing use of immobilizing devices (like bed and chair alarms), assuring orientation and cognitively stimulating activities, enhancing sleep without medications, avoiding dehydration and malnutrition and minimizing use of psychoactive drugs — those that adversely affect the brain, such as sleeping medications and tranquilizers.
Patients and families should be made aware that there is much that can be done, and helpful hints can be found on our website for the Hospital Elder Life Program.
What do you think is the most important thing people have yet to learn about the brain? 
The brain is incredibly resilient, and many people in their 80s and 90s never develop any cognitive impairment. We need to learn how to enhance this resilience and keep the brain highly functional throughout our lives, even with exposure to the many adverse factors that are a part of daily life for all of us.
Since delirium is especially common in patients with Alzheimer’s disease, how has your research influenced your views about the disease? 
I view delirium as a great untapped domain for Alzheimer’s disease research and treatment.
Understanding where the brain acutely goes wrong holds so many important lessons for the treatment of Alzheimer’s disease. Given that there is growing evidence that delirium can lead to dramatically accelerated cognitive decline in those both with and without Alzheimer’s disease, it represents a critical juncture where intervention may fundamentally alter clinical course.
Delirium and Alzheimer’s disease share many underlying pathophysiologic contributors, thus, preventing delirium may, in turn, prevent Alzheimer’s disease.
What impact will your research on delirium and cognitive decline have on healthy aging? 
Acute illness and hospitalization occur as part of usual aging for most older adults. Delirium occurs in a substantial proportion of these events and making sure people can survive and recover well is part of our mission.
Moreover, our research in delirium — and how acute stressors affect the brain — will advance our understanding of how to help the brain age successfully age.
Can people with Alzheimer’s and other dementias have a positive quality of life?
Most definitely. I have cared for hundreds of people with Alzheimer’s and related dementias, and my primary goal is to help them and their families maximize their quality of life. There is so much that can be done to enhance the quality of life, ranging from addressing daily activities to living situation to socialization to finding ways to keep them active and engaged.
We also work to help the caregivers understand the limitations while making the most of the situation. The specifics details of living need to change with dementia, but the quality of life need not be diminished in the early and moderate stages.
Each year, more than 12 million older Americans develop delirium. How do you hope your research will change the way patients with delirium are cared for in the future?
In the future, I hope that much of delirium is prevented through effective strategies that are already well-established. I hope health care professionals and systems recognize the importance of delirium and prioritize its prevention and management.
I hope that humanistic, person-centered programs like HELP can be implemented widely to improve quality of care for all patients.
What do you hope to achieve next? 
My hope, my dream is a world without delirium. To get there, we will need delirium prevention programs in every emergency room, hospital, ICU, post-acute and long-term care setting, and palliative care globally.
So that is my next goal.


The Relationship Between Delirium and Dementia

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the ninth in the series.) 
Dr. Bill ThomasDr. Bill Thomas  — founder of Eden Alternative, The Green House Project and Minka LLC — is an author, entrepreneur and doctor internationally recognized for his expertise in geriatric medicine and elder care. In 2015, Next Avenue named him one of its Influencers in Aging. Well known for his health-care system innovations, Thomas blogs regularly at ChangingAging, a platform he co-founded to challenge conventional views on aging.
In an interview with the Milken Institute Center for the Future of Aging, Thomas explains why it’s important to combat ageism and how care services for older people have improved over the years.
Milken Institute Center for the Future of Aging: Do you think we’ll ever be able to get rid of ageism? 
Dr. Bill ThomasDr. Bill Thomas: Ageism is a cultural construct. If the culture changes in a way that no longer supports judging people by their age, then ageism will wither away. There is nothing about ageism that suggests it is a permanent feature of human societies.
Why did you decide to launch ChangingAging? What is the mission and your vision for its impact?
The media is dominated by a narrative that deifies youth and disdains age. We found that the only time we could get coverage for our work was when we were, in some way, reinforcing ageist stereotypes. We felt we needed an alternative platform that could accurately reflect our point of view.
Collaboration is an important virtue for us, so we decided from the start that this would be a shared platform that would give voice to a wide range of people who want to change aging. In the end, it is stories that change the world and ChangingAging is a place where those stories can be told and shared.
Can you tell us more about your new initiative, Minka Homes and Communities? 
Housing is the axis around which independence turns. We learn this at a young age when we strive to “get a place of our own.” In later life, society gives us mixed signals. People are supposed to “age in place,” but then must occupy houses that were built for raising children but are bad for aging with independence.
We work with what we call the “triple alloy” of architecture, culture and technology. Minka exists to synthesize these three domains and use that synthesis to generate a whole new generation of independence-oriented solutions.
Our houses are intended to be the building blocks around which these new models can coalesce. They are compact, easy to assemble, employ advanced technology, adhere to universal design principles and are exceptionally easy to live in.
Do you think we’ll come to a point where we don’t need nursing homes?
We have already come to a point where we no longer need orphanages, insane asylums, TB sanitaria and leper colonies. Do I think that someday we will no longer engage in the mass institutionalization of people living with frailty? Yes, I do.
I think the buildings will survive, mostly repurposed for “higher” levels of care. The people will survive and find new ways of living and working. The policies will change, and the money that currently fuels the system will be exhausted.
In the long run, skilled nursing facilities will be seen as a fascinating social-cultural experiment, and many Ph.D. theses will be written about the history.
Older people will find and create clever new ways of protecting and extending independence.
What lessons have you learned since you began your mission of reforming long-term care? 
Patience is a virtue. The harder you push, the more resistance you inspire. I have come to prefer coalition-building. That might seem obvious, but it was not obvious to me for a very long time.
Also, creating a superior model that yields superior results offers no guarantee of success. All innovations are held to a de minimis financial model derived from an institutional model that many older people fear more than death. This constraint creates a powerful “lock in” advantage for existing facilities and services.
The low expectations generated by our culture’s pervasive ageism are part of a self-stoking cycle in which those expectations normalize poor outcomes that then reinforce low expectations. This is the true enemy of progress.
Do you think care services for older people are getting better or worse?
Better! WOW! So much better!
I am old enough to remember when older people were tied to the railings with bed sheets. I remember things being done to elders that are too horrible to write about. Over the past 30 years, we have experienced tremendous progress, and we have won many victories.
We need to celebrate those victories. And, we must also remember that we have a very long way to go. The trick here is to avoid both discouragement and complacency.
The ChangingAging Tour is a kind of theater piece that combines music, storytelling and neuroscience with the aim of changing people’s perception of aging. You’ve called it “a TED talk on steroids." Since 2014, it has played in 129 U.S. cities. Are there any plans for it to become global? 
We see The ChangingAging Tour’s unique form of “nonfiction” theater succeeding on the global stage, because aging is a universal human story. People all over the world struggle to reconcile the virtues and difficulties of aging with cultural biases that make it difficult to think clearly about aging.
This is why I am equally opposed to “positive ageism” that, in a sense, deifies older people and “negative ageism” that disdains them. People are people. Older people are people. In my experience, the arts have the best tools for reminding people of these fundamental truths.
What do you hope to achieve next?
My next project is MyMinka.com. I think I can launch a new approach to housing that is compact, affordable and explicitly supportive of aging with independence.


Saying No to Pervasive Ageism

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the fourth in the series.) 
Deepak ChopraDeepak Chopra, founder of The Chopra Foundation and co-founder of Jiyo ( a “well-being service provider” app) and The Chopra Center, is a world-renowned pioneer in integrative medicine and personal transformation. Time magazine has described him as "one of the top 100 heroes and icons of the century.” In an interview with the Milken Institute Center for the Future of Aging, Chopra spoke about his lifestyle choices for well-being and healthy aging and how people can use their brains to achieve health and happiness.
Milken Institute Center for the Future of Aging: Why did you decide to launch the Jiyo app? What is the mission and your vision for its impact?
Deepak Chopra: I launched Jiyo to create a global community for total well-being. I refer to Jiyo.com as the “internet of well-being,” a platform for people all over the world to get knowledge from experts in multiple areas: physical, emotional, professional, social, financial, and spiritual.
The experts are personally chosen and curated by me, and online courses are offered on everything essential to enhanced well-being and personal evolution — self-awareness, higher consciousness, sleep, stress management, meditation, movement, yoga, breathing exercises, nutrition, love, relationships and grounding.
My hope for Jiyo is to help create a critical mass of people engaged in personal and social transformation. Only then can we achieve what everyone desires, a more peaceful, just, sustainable, healthier, and joyful world.
How can we strive to find purpose and meaning in our lives?
Finding purpose and meaning in our lives demands that each of us reflect on fundamental questions: Who am I? What are the core values of my life? What do I want for myself and the world? And what am I grateful for? If we really investigate and are committed to these questions, life has a way of providing the answers.
What lifestyle choices have you made for your well-being and healthy aging? 
I’ve adopted the things that I recommend to anyone who wants enhanced well-being:
I sleep 8 hours every night.I practice meditation and yoga daily.I walk 10,000 steps every day.I cultivate healthy emotions like love, compassion, joy, gratitude and equanimity.I make sure my diet has a maximum diversity of plant-based foods. I avoid food that is manufactured, refined, processed and high in fat and sugar.I take a week of silence every year.Lately, as an experiment, I also ground myself to the earth through devices when I am in urban settings and am not in direct contact with nature.In our society, where some people do not get enough sleep, how important is having a restful night to the practice of meditation?
A good night’s sleep of eight to nine hours for the average adult is very important for experiencing the full benefit of meditation, beginning with inner stillness and alertness but also physical enhancements like improved self-regulation. If we have not slept properly, meditation generally turns into naptime.
Sleep, therefore, comes first. Along with [Next Avenue Influencer in Aging] Rudolph E. Tanzi at Harvard Medical School, we have created a brain entertainment device called Dream Weaver that helps people who have trouble falling asleep by getting them into the brain wave frequency that induces both the dream and deep sleep states.
How can people properly use their brains to achieve health and happiness?
The human brain has three components — the lower or instinctive brain, the emotional or limbic brain and the cortical or intellectual brain. By practicing meditation and self-inquiry, by cultivating healthy emotions, and by not being impulsive and reactive, we can integrate our three brains — this is conscious evolution.
Homo sapiens alone have the capacity to transcend genetic programming, which controls physical evolution. By pursuing evolution in a conscious way, we also enhance our capacity for insights, intuition, imagination, and creativity.
Are we missing key information about improving brain health?
Brain health was an obscure field 20 years ago, and many findings are still provisional. For example, it is strongly suggested that low-level chronic inflammation and treatable infections in the brain may be vital to preventing and perhaps curing Alzheimer’s disease —only time will tell.
In the meantime, the recommendations for brain health don’t vary greatly from general wellness practice:
Healthy sleep habitsStress managementHealthy emotionsHealthy nutritionRemaining curious, alert and mentally challenged throughout lifeWhat is brain plasticity and what impact does it have on disease prevention?
Brain plasticity means that the brain isn’t fixed and static. It has the capacity to increase the number of neurons, known as neurogenesis, and also the connections between neurons, known as synaptogenesis. Rehabilitation from strokes, for example, has been revolutionized since my days in medical school thanks to this new knowledge.
But for healthy people, brain plasticity can be enhanced through mental practices. I call these practices metacognition. Metacognition is conscious awareness of experience as it is happening, along with mindful awareness of our choices as we make them. These possibilities are discussed in Super Brain, coauthored by Rudy Tanzi.
How would you advise people who are going through difficult times? 
First, recognize that all experience is impermanent. The only invariant or non-changing factor in every experience is awareness. Cultivating self-awareness through a daily spiritual practice helps us navigate difficult times.
But everyone is different, and we have to be realistic. Advising someone suffering from chronic depression to be more self-aware is probably impractical when what’s needed immediately is to improve their symptoms and relieve their mental pain.
The real secret to happiness, however, is universal: seek your source in pure consciousness, and you will find that happiness is included in the ground plan of existence. Such an agenda is a tall order, I know, but this has been the ultimate cure for centuries and hasn’t worn out.


Deepak Chopra on Achieving Mind-Body Balance

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In this series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries are revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the tenth in the series.) 
From spearheading the Affordable Care Act to opposing the legalization of euthanasia, Dr. Ezekiel Emanuel continues to make his mark on health care. Emanuel, vice provost of global initiatives and chair of the department of medical ethics and health policy at the University of Pennsylvania, is a globally renowned oncologist and bioethicist, and author and contributor to numerous media outlets. In an interview with the Milken Institute Center for the Future of Aging, Emanuel explains the urgent need to improve quality of life and why we are getting further from an honest conversation about aging.
The Milken Institute Center for the Future of Aging: In your attention-getting piece in The Atlantic, you identified the age of 75 as a personal cut-off point for health interventions. You state: “Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either.” With what’s known about the distinction between chronological and biological age, why 75?
Dr. Ezekiel EmanuelDr. Ezekiel Emanuel: I think there are five or six different criteria. The first thing almost all of us will say is “I really care about quality of life, not quantity of life.” The question then becomes: when does quality of life begin to deteriorate?
Whether it’s cognitive or physical, 75 is a very important threshold. As we get older, our cognitive abilities decline — there’s a natural slowing down of the brain, a natural decrease in processing speed, a natural decrease in creativity. So, if you are interested in mental acuity, 75 is where you see a dramatic slowdown.
Similarly, you have a lot of physical decline and an increase in physical morbidity the older you become. For example, the inability to climb stairs or the inability to walk a quarter of a mile, these things begin to increase.
And if you look at the rates for Alzheimer’s and other dementias, they are relatively low pre-75, higher at 75 and then dramatically increase after 75. So, by 80, between a third and a half of people have dementia of some kind.
And finally, I would say if you look at the world’s literature on creativity and productivity and generating and thinking new thoughts, it’s very hard to find anyone after 75 who has done anything positive. I can think of four people in all of history where we see good evidence of their creativity, productivity and generation of thought post-75. You have Michelangelo, Benjamin Franklin, Goethe, and Verdi. What ends up happening in life is that you switch from being engaged with life to being much more passive.
Are we too focused on living longer?
Yes, and I think we delude ourselves about the wonderfulness of living long, and I think the advertising industry and others want us to be somewhat deluded.
Right after I published that article in The Atlantic, there was a big advertising campaign by AARP about how the beat goes on forever and so can my life. Then they show these very vigorous people, not very old, hiking in what looks like Montana. Around the same time, The New York Times wrote a big article on people in their 80s doing things like driving motorcycles and snorkeling. Those people exist, those activities exist, but they don’t show you the flip side.
In these ads, you didn’t have the full picture of just how many people are in nursing homes, people who were just sitting around in vegetative states or people who are unable to leave their houses. So, you get a much-distorted view of what it’s like to age.
If you read the literature of what’s happening in Japan, you get a lot of people who are lonely, their spouses died off, their friends have died off, their kids are off doing their kid things and they are left very much alone. That doesn’t seem to be a wonderful life.
So I think we need a much more accurate view of what it is to live a long life into your 80s and 90s.
I would say that for many, maybe even the majority of people, it isn’t so wonderful. Almost anyone you ask will say, ‘Yes, you’re right. I don’t want to just record the number of years, I want to have a high quality of life.’ But, in the end, the average lifespan in the U.S. has gone up another three months. What does that tell you? Well, we’re just counting numbers, we’re not counting quality. The average lifespan is not a quality measure.
Regardless of age, what health characteristics should people consider as they make care and treatment decisions and weigh age-prolonging options?
First, I think the most important thing is for people to consider, well before they get close to the end of life, or well before they even get to 70 or 75, is how they want their life to go. It’s the kind of thing you should consider when you’re 20, 30, 40, 50.
Henry David Thoreau talks about sucking the marrow out of life, and I think that’s what people ought to do — to stop worrying about ‘Am I going to make it to 80 or a 120’ I think when you start thinking that you’ll make it to 100, that may be a recognition that my previous or current life wasn’t that valuable or meaningful, and I sort of squandered it.
Be focused more on living a rich life rather than trying to get to 120 — that might be more valuable in my opinion.
How should public and private payers evaluate the returns on their investment in treatment and care?
An evaluation on care that does not prolong life over disease symptoms is hard to measure, and that could be very helpful to people at the end of life. We don’t want to waste money, so the return is either prolonging life, reducing symptoms, increasing convenience or reducing costs. We need to see those things from our medical interventions.
There is a growing effort for communities to be more age-friendly and celebrate the value and potential of older adults. Do you think these efforts are misguided? 
The reality for all older adults paints the full picture of aging. Most people who age will tell you that growing old is not for sissies. It’s hard. The face falls, the body begins to fall apart and the mind slows down. It’s not an ageist view. That’s just what happens when the body begins to age and deteriorate.
That’s also the way people’s mental capacity works — processing speed declines, memory capacity declines and the ability to find creative solutions to problems declines.
Yes, we’ve got a spectrum of people, of course, but it is true of the average, it’s true of the median, and it’s true of everyone that it’s going to happen at slightly different rates. I don’t think that’s ageist. It’s an easy charge for people to make when they’re trying to preempt a serious discussion about meaningful aging.
As a society, are we getting closer to or further from an honest conversation about aging?
I think in general we’re getting further away from honest conversations about everything in our society, because we’re unwilling to look at the facts and too willing to dismiss people with ad hominems and overall charges like ageism or discrimination.


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