Triumphs of Experience: The Men of the Harvard Grant Study

by Vaillant, George E.

  In 1980, Stanford University internist and epidemiologist James Fries recognized that modern medicine was not extending the human lifespan, and yet survival curves were changing. More people were living vitally until eighty-five or ninety, and then dying quickly, like the wonderful one-hoss shay in Oliver Wendell Holmes’s poem, which ran perfectly for a hundred years and then fell apart all at once.2

  Fries called this phenomenon “compression of morbidity.”3 In 1900, because most deaths were premature, the human survival “curve” was a diagonal line; now it is more of a rectangle—especially if you have no risk factors (Figure 7.1). In 2040 there will be ten times as many eighty-five-year-olds as there were in 1990. This is not because the normal human lifespan is any longer than it was, but because fewer people will die before eighty. After eighty the lifespan will reflect little increase. Medical advances like antibiotics, new cancer treatments, and kidney transplants all serve to decrease premature death. But they do not alter the fact that the bodies of most of us, like the one-hoss shay, have not evolved to live past one hundred.

  In 2012 the longevity of the Grant Study men, who were selected for physical health, is clearly ahead of the historical curve. While only about 3 percent of the white American males born in 1920 are expected to celebrate ninetieth birthdays, 77 (28 percent) of the 268 Study men already have, and 7 (3 percent) more are eighty-nine and likely to join them. Their projected age of death is already four years longer than that for white males born in 2009.4 (By way of comparison, only about 18 percent of the gifted Terman men made it to ninety.5) One purpose of this chapter, therefore, is to give readers a view into the future, to a time when living to ninety will have become more commonplace.

  Figure 7.1 Percentage of men alive at each age.

  Some may ask: How long do we want to live? Our society stereotypes the very old as frail, ill, and unhappy. No one likes the prospect of long years confined to a nursing home, helpless, mindless, or in pain. And it can’t be denied that aging means loss. Our bodies begin their long, slow process of failure at thirty; by age seventy we can identify only fifty percent of the smells we recognized at forty. Our vision declines until by eighty few of us can safely drive at night.6 Even among the surviving Grant Study nonagenarians, 25 percent are cognitively impaired.

  But that means that three out of four Grant Study ninety-year-olds are still cognitively intact. Although we often hear that our brains begin to shrink at twenty and that we will have lost fully 10 percent of our brain cells by seventy, modern brain imaging techniques suggest a less grim picture. Normal brain shrinkage is less than we feared, and estimates so far may also reflect the practice of averaging individuals with specific brain-destructive pathologies—Alzheimer’s, trauma, alcoholism—in with everyone else.7 In addition, we can speculate that some lost brain matter is the result of judicious “pruning” of cells that are no longer in active use; after all, due to such pruning, our brains contain fewer than half the synapses at twenty-one than they do at five.8 There may not be as much cause for despair as we fear.

  Furthermore, the mental life of the elderly is not as bleak as we are sometimes given to believe. After forty, the fear of death declines steadily and belief in an afterlife becomes more common. Careful epidemiological studies from multiple centers reveal that depression among the elderly does not increase.9 Indeed, recent studies show that older adults report less depression, lower levels of negative affect, and more assertiveness and positive emotion.10 As one Terman great-grandmother put it, “I hate my waist, but I love my psyche!” Most of the Grant Study men who reached their eighty-fifth birthdays were glad they did.

  The most authoritative study of old age available is the MacArthur Foundation study, which is summarized in Rowe and Kahn’s Successful Aging.11 That study refutes the specter of dismal years in a nursing home, finding that the average eighty-five-year-old man will spend only about six months in an institution before he dies, and the average eighty-five-year-old woman about a year and a half. People who live to be one hundred, those data show, are usually pretty active at ninety-five.

  In the Grant Study men, in fact, for a long time there seemed to be so little cognitive decline that we did not even begin testing them for cognitive function until they were eighty. At that time, 91 percent of them tested at normal levels. Of the seventy men who have so far survived to reach ninety, fifty-eight were cognitively intact at that age, and had showed over the preceding ten years an average decline of only one point on the 41-point Telephone Interview for Cognitive Status (or TICS).12 (I’ll say more about the TICS shortly.) Almost three-quarters of the Grant Study ninety-year-olds were as sharp as ever, if just a bit slower. It’s true that a majority could no longer give the full name of the vice president: “I know he was a senator from Delaware. . . .” Yes, finding names can be a problem after seventy. So can finding your car in a parking lot!

  The MacArthur Study supports Fries’s view that the years of disability are growing shorter even as we live longer. Bury and Holmes report that chronic pain declines from a high of 28 percent at eighty-five 13 And while dementia is to only 19 percent after ninety-five.ghastly for afflicted individuals and their families, in the Grant Study, only ten of the forty-one men who became demented before eighty-nine lived for longer than five years after their dementia was recognized. Moreover, some, although not all, epidemiologists believe that the incidence of Alzheimer’s declines after ninety-five.14

  Progressive diminution of physical reserves is an inevitable part of aging, but the rate at which this happens varies. Forty percent of the general population remains “fully functional” after eighty-five. That is a hard criterion to define, but as Table 7.1 illustrates, about 55 percent of the Grant Study men between eighty-five and ninety appeared to meet it. And only 9 percent of them were confined to home or wheelchair.

  Table 7.1 Instrumental Activities of Daily Living at Age 88 ± 1 (N=60*)

  * Sixty people returned this questionnaire.

  The questionnaires that the most energetic of the men returned at ninety (or almost) convey some of the flavor of their lives. One man who had been divorced four times described the happiness of his fifth marriage—which had lasted for twenty years—as 7 out of 7. He reported no cutbacks in any of his physical activities, except that he had given up night driving. For his energy level he checked “vigorous”; he continues to play tennis. Another man was still earning $60,000 a year at eighty-seven, and also engaging in thirty hours a week of volunteer activity. He, too, described his marriage as 7 out of 7, and at ninety he was sexually active. A third man exercised fifteen or more hours a week, was sexually active, and gave his marriage 6 out of 7 points. He engaged in four volunteer jobs.

  TWO LIVES

  The life of Alfred Paine. The realities of the men’s health and their subjective perceptions of it did not always coincide. Good self-care, high morale, intimate friends, and robust mental health often make the difference between having an illness and feeling sick. Let me now therefore give a more nuanced portrait of both ends of the aging spectrum, starting with Alfred Paine (previously discussed in Aging Well ), who was both ill and sick, as per my differentiation above. His greatest strength was that he did not complain; his greatest weakness was that he knew himself very little. He could not acknowledge either his alcoholism or his depression. Paine had one of the best scores in the study on a subjective inventory of depressive symptoms. He had never sought psychotherapy; none of his doctors had ever called him mentally ill. On questionnaires, he described himself as close to his children and in quite good physical health. It was only by interviewing him personally, talking with his wife, examining his medical record, recognizing the disappointment in his children’s questionnaires, and—finally—reading his obituary that Alfred Paine’s misery could be fully appreciated.

  His ancestors had been successful New England clipper-ship captains. One grandfather was a merchant banker; the other was a president of the New York Stock Exchange. His father had gr
aduated from Harvard and his mother from a fashionable boarding school. Paine himself arrived at Harvard with a handsome trust fund. But his childhood received the lowest rating for warmth of any man’s in the Study, and in the Grant Study, at least, parental social class does not guarantee successful aging. Paine’s story illustrates that money doesn’t, either.

  At college, Paine was often in love. But to the Study staff it appeared that to him, “being in love” meant having someone to care for him. His multiple marriages were all unhappy, especially according to his wives. This was partly because of his alcoholism (which he denied), and partly because he was afraid of intimacy.

  Paine described his physical health as “excellent” at sixty-eight; but objectively it wasn’t. He was seriously overweight, and he had obstructive pulmonary disease as a result of lifelong smoking. By age seventy, gallstones and an ileostomy for diverticulitis of the colon were adding to his medical woes. When I interviewed him at seventy-three, he seemed ten years older than his age—like an old man in a nursing home. He had lost all his teeth; his kidneys and his liver were failing; he had a mild dementia as the result of a drunken automobile accident. He took two medicines for high blood pressure, two for diabetes, one for gout, and one for depression. There was no question that he was physically disabled.

  Paine’s Decathlon score was 0. Alone of the men who returned the Study questionnaire at seventy-five, he refused to fill out the Life Satisfaction Chart that we included with it. But his joylessness was evident. I always found it exhilarating to listen to men who were zestfully mastering life’s slings and arrows, but interviewing Paine made me feel very sad. In his questionnaires, he said nice things about his children. But when I asked him what he had learned from them, he responded irritably, “Nothing. I hardly see my children.” One daughter said in her questionnaire that she saw her father only every three years, while the other saw him once a year and viewed him as having lived “an emotionally starved life.” Alfred Paine’s only son said that he had never been close to his father.

  Paine’s third wife was protective and loving toward him, but he was disrespectful to her, and not very caring. I asked him once how he and his wife collaborated, and he replied, “We don’t. We lead parallel lives.” It doesn’t help to be loved if you can’t let yourself feel it.

  When I asked Paine at seventy-three to describe his oldest friend, he growled, “I don’t have any.” He could climb stairs only with difficulty and he had great difficulty walking even 100 yards; he couldn’t drive at night, and he had had to give up golf because of his gout. Both his wife and his doctor saw him as seriously impaired. Yet on his last questionnaire, in a shaky hand, the seventy-five-year-old Paine called his general health “very good” and reported that he had no difficulty with physical activities. The very next year he was in a nursing home; a year after that his multiple illnesses had killed him at an age when two-thirds of his Study-mates were still alive. Paine’s way of dealing with trouble was to wear blinders all the time—a striking contrast with the always-game Boatwright and Adams, who relied on rose-colored spectacles, but mostly to help themselves keep up the good fight.

  The life of Daniel Garrick. I never met Daniel Garrick, although I tested his cognitive function by telephone three times—when he was eighty-one, eighty-six, and ninety. I was impressed that he did better at eighty-six than at eighty-one. When I called that middle time, Garrick told me that I was lucky to have gotten him on his day off; he worked the other six. He was very excited about having just taught his first course at the San Francisco Art Museum—on American painters, complete with his own slides. I chose him as a counterpoint to Alfred Paine’s early decline and miserable last years on the basis of those phone calls, and because I knew that at ninety-five he was the oldest living man in the Study. However, I didn’t know much about his life before he turned eighty, so I had to read his record from the beginning.

  Garrick was the oldest of six children. He grew up during the Depression in a family whose yearly income per person was $400—that was $3,200 per year total for a family of eight. His father, an accountant with a high school education, was often unemployed, and couldn’t understand his son’s decision to go first to acting school and then, at twenty-five, to Harvard. Garrick’s father was a very conservative man who read only the Reader’s Digest, but his mother was a sensitive, artistically inclined liberal, and Daniel modeled himself on her. The Study raters considered his childhood average for warmth.

  Daniel was bottle-fed. He was fully toilet-trained by one. From the beginning, he was a “good-natured” and “very friendly” child. In school he got bullied by older children, was completely incompetent at all sports, and failed algebra. But in the ninth grade he had his first success in a school play. He loved the applause, and from then on he devoted himself to school theatricals, at which he excelled. Upon graduation from high school, he enrolled in drama school. He rejected New York’s bohemian life and at that time didn’t drink or smoke, but he took part in summer stock productions every July. He only wanted to act in plays by serious playwrights like Shakespeare and Ibsen, and he had an idealistic wish to invite the public (perhaps primarily his philistine father) into the aesthetic realm that he and his mother inhabited with such pleasure. He wasn’t able to support himself as an actor in Depression-era New York City, however, and he came reluctantly to the conclusion that he was too emotionally inhibited to be a successful actor, despite his passion for the theater.

  Garrick resigned himself to a future of stage managing and teaching drama in some small college. To this end he put himself through Harvard without family help or scholarship support. A private mental hospital gave him room and board in return for working the graveyard shift as a psychiatric attendant. He would sleep from 6:00 p.m. to midnight, cover his shift (which gave him some time to do his homework), and then bicycle the five miles to Cambridge at 8 a.m. to save the carfare. Reading this tale of an iron constitution, I found myself wondering about the truism that exercise leads to long life. Maybe it’s the other way around. Maybe some people are just born with the stamina to live to ninety-five, and that stamina makes them good exercisers, too.

  Even with his great physical toughness, Garrick’s college life was difficult. He had only five dollars a year to spend on clothes. There was no time for a social life—no dances, no dates, no sports. He was chronically tired and unable to earn better than C’s until he married, just before his senior year. Once his wife, a young summer stock actress, started helping with expenses, he received honor grades.

  The Study staff did not all relate to Garrick. He received one of the top ratings in the Study for being “well-integrated” and “self-starting,” and one observer appreciatively called him an “intense fellow.” But when he was twenty-six, the Study psychiatrist summed him up this way: “He was chosen for the Study for outward manifestations of good health and stability. He has actually attained only very modest success in the field he has sought. . . . Although he has some insight and is making progress in understanding himself, he does not yet, and probably never will, reach the understanding necessary to be a happy person.” The Grant Study was not always good at understanding artists—it rejected Norman Mailer and Leonard Bernstein!—and despite his manifold successes, Garrick’s score on the Decathlon was only 3—average.

  A decade after he joined the Study, Garrick was given a “D” for personality stability, a “D” for mental and vascular health, and a “B-” for projected longevity. Even Clark Heath called his health only “fair.” The case discussant dismissed Garrick’s wish to share his cultural pleasures as the “prestige motivation” of a show-off. Another staff member predicted “character disorder.” The Study staff of the time expected people to aim at business, law, or medicine, and there definitely seems to have been a blind spot for artistic types.

  Garrick was thirty-three when his local repertory theater went bankrupt. “My nerves were torn to shreds,” he wrote. Still too emotionally constrained to act,
he gave up theater work as too stressful, and returned to a safer goal. At forty he saw himself as “mediocre and without imagination,” but he acquired the necessary Ph.D. and set out to make his way teaching drama and theater history in the “small college” of his imagination.

  When I got to this point in my reading, I began to fear that my memory was playing tricks on me. Was I erroneously recalling the delightful telephone conversation of ten years before? Was my exemplar nonagenarian really a depressed narcissist? I didn’t yet know that his doctoral dissertation had been published and won prizes, or that, when he was eighty-eight, a grateful former student gave his college a substantial gift in Professor Daniel Garrick’s name. All I could see in Garrick’s future was years of disappointment. Like Garrick himself, I viewed him as a failure.

  My anxiety drove me to cheat. I opened his latest Study folder, where the first thing I saw was a newspaper clipping. Actually it was more than a clipping; it was the whole front page of the San Francisco Chronicle’s Sunday Arts section. The headline read: “For Daniel Garrick, 89, It’s Always a Full House.” I heaved a sigh of relief and went back to the chronological story. As Freud once said, “Before the problems of the creative artist, analysis must, alas, lay down its arms.”15 Clearly I had more in common with those early Study investigators than I wanted to acknowledge. I needed a reminder that artists need time to mature. Another reason for longitudinal studies. . . .