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We have worked very hard
to achieve living longer

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and yet today we consider
aging as a problem.

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I also used to consider
population aging as a problem,

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that's why some years ago I packed, 
left everything behind

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and enroled a top university in the USA,
Johns Hopkins University,

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to acquire tools that'd help me
to fight the aging challenge.

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What I was not expecting
was to realize that my initial vision,

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my perspective on aging, was distorted.

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I had a series of beliefs,
stereotypes and prejudices

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that prevented me from seeing clearly.

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We can think of aging either
as positive or as negative

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but we all share one thing:

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That idea is conformed
very early in our lives.

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Studies in the '70s

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conducted interviews
on 4 to 11 year-old children,

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a gerontologist, Seefeldt, and others

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asked children about
their perception of the elderly.

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Results are horrifying.

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Two out of three children
believed that older people

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were helpess,
unable to take care for themselves,

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and generally passive.

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And that negative perception
they had about aging

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would also become
an expectation of their own aging.

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60 percent of those children

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already predicted that when they'd be old,
they were going to feel awful.

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And how can any 4, 5 or 6 year old
know how'd they feel when elderly?

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Probably, what goes on there
is that we are absorbing

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that stereotype and that belief
from our environment.

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Actually, in the Western world,
Europe and North America,

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there's generally
a very negative perception of old age,

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it's what we call "ageism"
or discrimination by age.

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And what happens 
when those children grow up?

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By then the stereotype is reinforced,

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the belief is replayed

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by the mass media, advertising, movies --

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If you give a closer look,
how is aging usually portrayed?

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Generally not positive.

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At most it's warm, 
but never as an active aging.

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Actually, in the 90s 
another very interesting experiment

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was conducted by Burke
on healthcare professionals.

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He wanted to analyze
why some health professionals

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would talk to older people 
as if they were children,

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we call this the "elder talk",

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probably most of you have done it
or at least have seen it:

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"Hi Carmencita, how are you today?

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Here is your little pill for the heart".

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Right? And Carmen is 75 years old,
a professor emeritus at university

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and she is in perfect cognitive state.
(Laughter)

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Burke proved that healthcare professionals

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would speak like this to the elderly

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regardless of their cognitive state,

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based only on their own beliefs 
about old age.

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I invite you to never talk like this
to an older person.

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(Applause)

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In 2008 an article in The New York Times

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gathered all the scientific evidence

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of why talking like that to older people

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is harmful to their health.

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In a very simple way we can realize
we are reinforcing their idea

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that they are useless and incapable.

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No, the elderly are not like children.

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In another very interesting study 
also starting in the 70s

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a gerontologist, Ashley,
went to a town in Ohio

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and managed to convince 
2/3 of the population over 50

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of participating in it.

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That's an achievement for any researcher

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because nobody wants to take part
in scientific studies,

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less if they are periodic.

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These people were periodically asked

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about their mental health status, 
their physical health status,

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their working environment, family, etc.

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And they were also asked some questions
on their perception of old age:

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Do you think you become less happy
as you get older?

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Do you think that as you get older
you are less useful?

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Well, this study was very interesting,

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and had the most powerful results 
15 years later.

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A social psychologist, Becca Levy,
from Yale University,

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has revolutionized the world
-- at least for me, my world --

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by proving that
the negative stereotype of old age

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becomes a self-fulfilling prophecy.

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Meaning that it affects our health,

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if we think we are going to age badly,
we most probably will.

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Becca Levy with her Ohio study
resolved to test an hypothesis:

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do people with a positive vision
of old age live longer?

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She went to Ohio and retrieved 
all the death certificates

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from people participating on the research
who had already died

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and compared the life expectancy 
of people with a positive vision

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with those who had
a negative vision of old age.

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And she found that those
with a positive vision lived longer.

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How much longer do you think they lived?

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One year? Two years?

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It's 7.6 years!

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That is 7.6 years more of life expectancy

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in those with a positive vision of old age.

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Monitoring all other factors.

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Do you know how much it costs as society

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to increase life expectancy ...
in 3 months?

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"With surgery ... got another year
of life expectancy ..."

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Changing our attitude.

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A change in our beliefs about aging.

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And how can a belief become
a change in your cells,

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in your life expectancy?

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It's very revolutionary.

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Well, they've managed to understand

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how the negative stereotype
is associated to things like memory,

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to our performance in cognitive tests.

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In 2013, they managed to associate
the negative vision of old age

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with the size of our hippocampus.

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So, our ideas change
the anatomy of our brain.

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And to apply it a little in our day to day

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there are many hypotheses
of how this happens,

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what is the biological mechanism,
how does this happen?

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But there's one thing that
we have all said or listened,

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that is: "Me, at my age..."

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"What am I doing
wearing sneakers at my age?"

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"What am I doing in the gym at my age?"

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"What am I doing, being 40,
with those who are 20?"

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Suddenly, we stop doing things
that are good for our health

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because there's some kind
of expiration date

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from which we throw in the towel.

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It seems like the day we turn 65,

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"game over", we are done,

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we can no longer introduce any
positive activity for our health

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because it's not worth it,
there's no turning back,

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aging is negative by definition,
it is inexorable.

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Actually that number, 65 years,

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I tried to find out where it came from,

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and the most probable cause
is called Otto Von Bismarck,

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who was the German Chancellor
in the late 1800s.

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In 1893 he introduced
the world's first retirement policy.

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The right to retirement is very recent,

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the workers were protesting a lot

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and he wanted to calm things down a bit,

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so he stablished
the retirement age in 70 years.

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When I researched a little

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about which was the life expectancy
in Germany in 1893 --

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(Laughter)

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How long do you think
people lived in 1893?

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Life expectancy at birth was 39 years old.
(Laughter)

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Otto Von Bismarck was a genius --
(Laughter)

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Those who were lucky
and managed to reach 30,

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would live on average
another 30 years, that is, 60.

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Otto Von Bismarck lived up to 78,
more or less,

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good for him, but not for the rest.
(Laughter)

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Can you see there's no ground for this?
There is no medical basis for 65.

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The other countries acquired
that number, 70, 60 --

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actually, in the United States
it's said that 65 was adopted

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because someone said "60", 
another said "70",

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and a third said "let's not argue: 65".

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And now in the collective mind
it has become some kind of halfway point

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in which we go deep into
not having a solution nor remedy,

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and we do have a remedy.

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There are changes in our lifestyle
that'd benefit us no matter when,

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for example, if after this talk 
you resolve to quit smoking,

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tomorrow, in 24 hours,
your cardiovascular risk

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would have decreased,
regardless of your age:

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20, 40, 60, 80...

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In two days, you'd recover
your senses of smell and taste.

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Reducing our overweight, 
that constant struggle,

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at any time of our life,

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even if we are 80 years old,

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reducing overweight is positive,
especially abdominal fat,

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the belly, which is a very important
predictor of cardiovascular events,

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I'm sorry to break it to you.
(Laughter)

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And let's point out not only
the most physical things

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but also the cognitive and social,

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how about signing up to do something new,

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enroll a course, meet new people.

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The social environment, the people we meet

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is also essential in our aging,
in our life in general.

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When I started researching,

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my goal was to find
preventive medicine interventions

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that could improve the quality of life
and life expectancy of older people,

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not only consider prevention in children,

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but also in older people.

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And I, as a doctor,
thought about the classic issues:

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overweight, tobacco,
excessive alcohol, sedentary lifestyle --

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However, as I was researching,

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I had a US database which is
representative of the whole country,

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its results are very solid,

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and people over 65

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were asked three questions
about their neighborhood:

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Do you think that your neighbors
know each other well?

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Do you think that those neighbors
are willing to help each other?

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Can you trust your neighbors?

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It's a measure of social cohesion

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that sociologists used for other areas,

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not for preventive medicine.

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But it caught my attention
and I included it in my models.

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And it turns out that people
who had a high social cohesion,

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feeling that in their neighborhood people
knew, helped and trusted each other,

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they have a 40 percent lower risk
of suffering a cardiovascular event.

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Besides the classic risk factors,

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there's also the social risk factors,

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and our neighborhood, our environment,
is very important for our health.

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Your neighbors affect your health. 
(Laughter)

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And you, are you good neighbors?

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Do you greet?

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There's a lot of scientific evidence
being published and accumulating

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on how neighborhoods affect health,
not just the social environment,

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but also the physical,
sidewalks that are walkable.

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Actually here in Spain
there is a leading group

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at the University of Alcalá de Henares,

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I recommend checking their results
because they are fascinating.

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I believe that in the future
the real state ads will say:

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two bathrooms, one bedroom,
and social cohesion.

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(Applause)

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And how should your neighbors be,
how a neighbor affects you,

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-- besides you liking them more or less --

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how does a neighbor affect
your cardiovascular risk,

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it's a leap.

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There are many mechanisms of action 
and also different hypotheses,

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but I believe that
a very simple one is walking,

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specially if we are considering
people over 65,

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to whom walking is perhaps
the easiest physical exercise

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and the most recommended.

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Do you think people not feeling safe
or sheltered in their neighborhood

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will practice physical exercise in it,
or go for a walk?

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How important it is
to go for a walk accompanied.

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I was fascinated by a paper
published in 2016,

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also in Madrid, at Universidad Autónoma,

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at the Department of Preventive Medicine,

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leading in cardiovascular research,

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they are doing a research relating
hypertension or blood pressure

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with social support.

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A very intelligent researcher
had the idea of introducing this question:

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Do you walk alone or accompanied?

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People who walked accompanied
had less nocturnal blood pressure.

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It was hugely beneficial for their health

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because it is not just walking
and moving the muscles, legs or heart.

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It's also the company, talking.

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Aging is not a problem,

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aging is a privilege

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and a fact.

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In little more than ten years

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we will be one of the oldest countries
in the world.

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Of every three persons,
one will be over 60 years old.

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Where do we want to grow old?

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Where do we want our parents to age,
or our grandparents?

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In what society?

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We have to get rid
of that negative vision of old age,

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first because it affects our health,

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and second because
it affects the health of others.

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I invite you to question these stereotypes

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that are sometimes unconscious,

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about what a person can or cannot do
based on their appearance.

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00:15:15,640 --> 00:15:18,480
And I also invite you to build a society

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in which we all fit,

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a person of 20, a person of 80,

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a person pushing a cart
and a person carrying a cane

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or in a wheelchair.

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A society in which
we can age with quality,

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in which we can age with health,

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in which we can grow old
walking together.

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00:15:42,429 --> 00:15:43,600
Thank you very much.

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(Applause)