The Secrets of Living to 100 (2024)

Yet, when asked about the biggest change she’s seen, this witness to world-altering events says…the fridge.

“We didn’t have refrigerators then,” Flashman says, recalling the un-electrified, wooden icebox of her 1920s childhood and the periodic visits by the iceman, selling ice blocks for 60 or 80 cents, “depending on the weight.” She’s bemused by the potency of this seemingly small-bore memory. BU researchers, by contrast, are awed by her prodigious recollection and longevity. Flashman, who lives in a fourth-floor condo at a landscaped complex outside Boston, celebrated the start of her second century with a birthday lobster roll, and she drove until the pandemic, before donating her car to a public radio station. That’s why Thomas T. Perls recruited her to BU’s New England Centenarian Study (NECS), which he has codirected since the first of its four research projects launched in 1995.

Flashman earned a bachelor’s degree from the now-defunct BU College of Practical Arts & Letters and her master’s when SSW was in the Back Bay. Though Flashman’s degrees bear the signature of Daniel Marsh, the president BU’s chapel is named for, she graduated four years before that landmark’s cornerstone was laid on the then-scantly developed Charles River Campus.

Over those three decades, Perls, a BU Chobanian & Avedisian School of Medicine professor of medicine, has studied thousands of long-lived individuals, pursuing the secrets to their fountain of healthy longevity. “By determining how centenarians and their relatives age so slowly and markedly delay or even escape aging-related diseases,” the NECS website says, “we hope to contribute to the development of strategies and even drugs that do the same in average aging people.” That includes Alzheimer’s disease, scourge of an estimated six million American seniors.

The quick version of 30 years’ research: It’s likely that superagers such as Flashman won the genetic lottery. Eating right, exercising regularly, getting enough sleep, and de-stressing can stretch the expiration date for many of us to around 90, Perls says. But three digits? That takes a combination of protective genes that, together, shield their bearer against the illnesses of aging.

Centenarians generally have the average person’s number of disease-promoting genetic variants. But they may also have variants that shield against heart disease, stroke, cancer, diabetes, Alzheimer’s, and other diseases of aging. Perls and his NECS colleagues have also discovered that superaging runs in families. Flashman’s uncle, Joe Goldstein, was one of Perls’ first study participants, dying at age 102.

The four NECS studies gather extensive data on participants. Debbi Cutler (SSW’89), Flashman’s daughter, recalls that in addition to basics like blood samples, Perls’ team collected reams of information regarding her mother’s personal and medical histories, using forms going into minute detail. “They ask, ‘When you were a kid, how many hours a day did you spend reading, [or] playing cards?’” Cutler says. “She remembered more than I did.”

The Formula for Healthy Aging

Perls found his calling after first being repulsed by the shoddy care given to older adults, then amazed by how some aged so well.

As a teenaged nursing home orderly in 1970s Colorado, “I just saw some pretty horrific things going on,” he says. “Anybody with any kind of behavior issue was put on an antipsychotic. It felt a little bit like the lobotomy in One Flew Over the Cuckoo’s Nest.” Then, post-medical school, he cared for his first two centenarian patients during a fellowship at a rehab center. Their robust health stunned him.

“I immediately wondered why they didn’t have Alzheimer’s disease, because the pervasive wisdom at the time was that since Alzheimer’s had an exponentially increased rate of prevalence after the age of 85, everybody at 100 must have Alzheimer’s,” Perls says. “Well, these two definitely did not. And I wanted to then go out and find more centenarians and see if they were this natural model of resistance or resilience to aging.”

He summarizes what it takes to be a centenarian with an invented word: SAGEING. The acronym is for seven behavioral and other factors that can get many of us to age 90, and a lucky few beyond that: sleep (“not getting enough sleep has been associated with increased risk for Alzheimer’s and other dementias”), attitude (research suggests optimism and extroversion “are conducive to getting to older age”), genetics, exercise (“at least five times a week, 30 minutes each time”), interests (passions that get you out of bed, “exercising your brain as much as exercising your muscles”), nutrition (“as much non-red meat as possible, fish is good, maybe a little bit of poultry” and aiming for a healthy weight), get rid of smoking and “quackery,” like growth hormone.

These factors form the basis of Perls’ 40-question longevity calculator, which yields an estimate of the age to which you’ll live. (Sixty-three-year-old Perls clocks in at 94.)

Flashman has always practiced “E” (exercise) and “N” (nutrition). She’s watched what she eats, and while “I’m not a great athlete, I loved different sports,” including field hockey, tennis, and fencing. She smoked in college but dropped the habit after having kids. Flashman also credits “I” (Interests). “Recently, if I wasn’t able to Zoom, I’m not sure I would be alive. Because I’ve taken courses online.” She took in-person classes, too, pre-COVID.

Perls notes a vital caveat to SAGEING. “Those who are the victims of structural racism really have the deck stacked against them, in terms of being able to have proper access to medical care, screening and prevention, vaccinations,” he says. “If we did as good a job of screening and preventing hypertension in Black people as we do in white people, a huge chunk of the life expectancy disparity would disappear.”

A More Youthful Cognitive Function

During a visit last year with Flashman, Perls secured her agreement to undergo neuropsych testing to see if she’d qualify for a study of cognitive superagers, RADCO (Resilience/Resistance to Alzheimer’s Disease in Centenarians and Offspring), one of the four projects under NECS. “These are 100-year-olds and older who have the cognitive function of people 30 years younger,” says Perls. “If you’re cognitively intact like that at 100, you’re virtually immortal.” RADCO participants donate their brains postmortem for study, in part to see if they had any evidence of Alzheimer’s. If so, “how did they have neuropathology consistent with Alzheimer’s and yet they were cognitively intact? What’s protecting them?” asks Perls.

“May find out that I have Alzheimer’s,” Flashman quipped when Perls floated the idea of her joining the study. “I promise you that’s not the case,” he replied. She agreed that, should she qualify, she’d be willing to donate her brain after she passes away, eliciting the doctor’s delighted, “Bingo!”

Thomas T. Perls recruited Flashman to the decades-old New England Centenarian Study; her late uncle was one of the study’s first participants.

Other programs in the NECS include Integrative Longevity Omics, a study of about 1,400 individuals, two-thirds of them centenarians and the remainder their offspring; the Longevity Consortium’s Centenarian project, which aims to find healthy-aging therapeutics; and the Long Life Family Study, which started in 2004 with members of 550 families that had clusters of exceptionally long-lived members. “We want to find the familial factors that these families, individually and as a whole, have in common” that enable longevity across generations, Perls says of the family study. “This study will go on forever, I hope.” The National Institute on Aging funds all the studies.

Brains in a Dish

You don’t have to die to give the researchers a crack at your neurons, though. While visiting with Flashman, Perls also persuaded her to give a blood sample for coresearchers who make “brains in a dish.” These are lab-made neurons, developed from patients’ blood cells, which are used to test how brain and other cells react to stress and fight off disease.

George Murphy, an associate professor of medicine at BU’s medical school and a cofounder of its Center for Regenerative Medicine, describes how you make a brain: “We collect a teaspoonful of blood from centenarians and reprogram these samples into personalized, master stem cells, called induced pluripotent stem cells.” The lab takes these cells and “coaxes them into a host of cell types that are impacted by aging.”

One such cell type, cortical neurons, can reflect diseases such as Alzheimer’s. “We hypothesize that individuals with exceptional longevity share protective molecular profiles that regulate stress response and promote [cognitive] resilience,” says Murphy. To test that hypothesis, PhD student Todd Dowrey (CAMED’25) doses the lab-made neurons with stress-inducing materials to learn how superagers and their brains fend off aging’s infirmities.

PhD student Todd Dowrey (CAMED’25) studies an image of lab-made neurons.

BU’s stem cells bank has collected blood samples from 42 people—some older than 105—including the children of superagers. The Holy Grail of this work is insights about how the rest of us might live cognitively healthier lives. “We are beginning to uncover a compelling story,” says Murphy. It appears that superager-derived neurons boost genes that help adapt to aging and cognitive issues. Centenarians also may possess elite immune systems that help ward off debilitating disease.

The beauty of these stem cell lines is that they can be grown indefinitely, Murphy adds, “creating a permanent repository of biomaterial that can be used to fuel any aging study.”

Life itself isn’t permanent, but Flashman is hoping her twilight years contribute to mind-blowing knowledge that leads to healthier longevity in others. That would cap a lifetime devoted to healthcare. After graduating from BU, the School of Social Work hired her to organize a student unit in the psychiatric clinic at what is now Boston Medical Center, the University’s primary teaching hospital; after that got off the ground, she taught casework and human behavior, took time off to raise her family, then returned to teach and develop a course in family therapy. The latter effort included two weeks in Italy to learn from renowned family therapists. She became a charter member of the American Family Therapy Academy.

“Having taught at BU, and knowing how important research was—the dollars they get from that,” she laughs, “I was glad to help out [Perls’] research. I think that, you know, a good citizen would do that.”

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