For men, avoiding certain risk factors in middle age can increase the likelihood of surviving to 85 years of age from 9% to 55%, according to results of a large US study (JAMA 2006; 296:2343-2350).

For the study, 5820 middle-aged men from Hawaii were followed for up to 40 years; 42% of the men survived to the age of 85 years. Factors associated with overall,as

well as exceptional (to age 85), survival were high grip strength and avoidance of overweight, hypertension, hyperglycaemia,

smoking and excessive alcohol consumption. Higher levels of education and avoidance of hyeprtriglyceridaemia were also associated with exceptional survival. However, not being married was associated with death before the age of 85 years.

The association with grip strength suggests that it is important to be physically robust during middle age, the authors said. "This is consistent with theories of ageing that suggest that better built organisms last longer and that physiological reserve is an important determinant of survival'' they said.

Several risk factors that reflect insulin resistance were associated with overall survival and healthy survival, which is consistent with current theories that regard insulin as a modifier of the ageing process, the authors said.
Level of education was the most powerful sociodemographic attribute of exceptional survival, and it would be interesting to determine whether those who continue to engage in further education as adults (`life-long learners') are healthier at very old ages and live longer than those who do not, they said.

At the age of 55 years, many men face significant midlife decisions about risk factor modification, such as potential changes to physical activity, smoking and other lifestyle habits, the authors said. As such, information about the potential benefits of such changes in terms of adding healthy years to their lives could be highly motivating, they said.