Centenarios (Poulain 2022)

Positive Ageing and Learning
from Centenarians
Positive Ageing and Learning from Centenarians evaluates the mechanisms of posi-
tive ageing in a uniquely interdisciplinary way to explore the questions of how
we age and how some people age successfully.
Drawing together the findings of recognised longevity researchers from
around the world, the book applies an integrated vision to educational and
social aspects of human ageing. It examines research among centenarians,
and considers most of the disciplines related to longevity and healthy ageing
and aspects such as education, psychology, philosophy, anthropology, demog-
raphy, sociology, economics as well as those related to nutrition and biological
factors of longevity. The book examines how the results of these scientific
investigations could improve the well-being of the oldest olds in the future,
especially in the context of ageing societies. It provides answers to the questions
of what we can learn from centenarians and what lessons we can take from
their lifestyle, which can contribute to live longer, better and happier.
Based on the cutting-edge research, this book will be highly relevant reading
for researchers, academics and students in the field of ageing and longevity,
mental health research, health science, gerontology and psychology.
Michel Poulain is Professor Emeritus at Université catholique de Louvain,

Belgium, and Senior Researcher at Tallinn University, Estonia. He specialises in
longevity studies and is the initiator of the concept Longevity Blue Zone.
Jolanta Mackowicz is Associate Professor at the Pedagogical University of

Krakow, Poland. She specialises in gerontological research.
Aging and Mental Health Research
Series Editor: Martin Orrell
In the 21st century, the world’s aging population is growing more rapidly than
ever before. This is driving the international research agenda to help older people
live better for longer and to find the causes and cures for chronic diseases such as
dementia. This series provides a forum for the rapidly expanding field by investi-
gating the relationship between the aging process and mental health. It compares
and contrasts scientific and service developments across a range of settings, including
the mental changes associated with normal and abnormal or pathological aging,
as well as the psychological and psychiatric problems of the aging population.
The series encourages an integrated approach between biopsychosocial models
and etiological factors to promote better strategies, therapies and services for
older people. Creating a strong alliance between the theoretical, experimental and
applied sciences, the series provides an original and dynamic focus, integrating the
normal and abnormal aspects of mental health in aging so that theoretical issues
can be set in the context of important new practical developments in this field.
In this series
Perspectives on Behavioural Interventions in Palliative and

End-of-Life Care
Edited by Rebecca S. Allen, Brian D. Carpenter and Morgan K. Eichorst
Perspectives on Palliative and End-of-Life Care

Disease, Social and Cultural Context
Edited by Rebecca S. Allen, Brian D. Carpenter and Morgan K. Eichorst
New Developments in Dementia Prevention Research

State of the Art and Future Possibilities
Edited by Kate Irving, Eef Hogervorst, Deborah Oliveira and Miia Kivipelto
For more information about the series, please visit: www.routledge.com/

Aging-and-Mental-Health-Research/book-series/AMHR
Positive Ageing and Learning
from Centenarians
Living Longer and Better
Edited by
Michel Poulain and Jolanta Mackowicz
First published 2022
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2022 selection and editorial matter, Michel Poulain and Jolanta Mackowicz;
individual chapters, the contributors
The right of Michel Poulain and Jolanta Mackowicz to be identified as the
authors of the editorial material, and of the authors for their individual chapters,
has been asserted in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record has been requested for this book
ISBN: 978-0-367-75363-4 (hbk)
ISBN: 978-0-367-75364-1 (pbk)
ISBN: 978-1-003-16221-6 (ebk)
DOI: 10.4324/9781003162216
Typeset in Bembo
by Newgen Publishing UK
Contents
List of figures vii

List of tables viii
About the editors ix
About the contributors xi
Preface xix
1 Blue Zone: a model to live longer and better 1

MICHEL POULAIN AND ANNE HERM
2 Impact of aging society on expectations of aging self in

younger population 18
SAORI YASUMOTO AND YASUYUKI GONDO
3 Intergenerational transmission of values of Polish

centenarian teachers 31
JOLANTA MACKOWICZ, JOANNA WNEK-G OZDEK AND EWA SLIWA
4 Exceptional longevity: exploring personality factors and

resilience in the life stories of Canadian centenarians 49
MARTINE LAGACÉ AND CAROLINE D. BERGERON
5 Ikigai: meaning of life and other psychosocial factors

for longevity 64
SABINA MISOCH
6 Life satisfaction and survival in centenarians 75

LAETITIA TEIXEIRA, LIA ARAÚJO, ROSA MARINA AFONSO,
CONSTANÇA PAÚL AND OSCAR RIBEIRO
7 Longevity and the role of biological factors in the context

of lifestyle 96
JACEK M. WITKOWSKI, EWA BRYL, ANNA MIKOSIK-ROCZYŃSKA
AND TAMAS FULOP
vi Contents
8 Longevity: cultural and social influences of a unique

non-Western lifestyle 111
KALLOL KUMAR BHATTACHARYYA AND VICTOR MOLINARI
9 A closer look at life expectancy among cohorts of Danish

centenarians 128
ANTHONY MEDFORD AND JESÚS-A DRIÁN ALVAREZ
10 Environmental support among centenarians 138

PETER MARTIN, ROTEM ARIELI AND JOSEPH KIM
11 Implications for ageing society 153

MICHEL POULAIN AND JOLANTA MACKOWICZ
12 Concluding remarks and reflections 164

MICHEL POULAIN AND JOLANTA MACKOWICZ
Index 168
Figures
1 .1 Spatial distribution of centenarians in Sardinia 4

1.2 Geographical location of the Blue Zone in Ogliastra, Ikaria,
Nicoya peninsula, and Okinawa 5
2.1 The silver sake cup which was given by the prime minister 20
2.2 The letter of commendation from the governor for the
celebration of the 100th birthday 21
6.1 Kaplan–Meier survival curve 83
6.2 Rank-hazard plot of multivariable model where the hazard
of death is explained by satisfaction with life (SWL),
institutionalized (Inst.), functional capacity (ADL), and frailty 84
6.3 Distribution of five items of SWLS 85
9.1 Cohort life expectancy at age 100 for 10-year cohorts of
females born between 1850 and 1904 its 95% confidence
intervals 131
9.2 Mortality hazards at age 100 across cohorts of females born
between 1860 and 1904 132
9.3 Heatmap of annual rates of mortality improvement 133
Tables
3 .1 Characteristics of studied cases 33

6.1 Sociodemographic, health, and social characteristics of
the sample 82
6.2 Estimated unadjusted and adjusted hazard ratio (HR) and
95% CI for overall survival 83
6.3 Association between satisfaction with life and
sociodemographic, health, and social factors 86
6.4 Multivariable linear regression model with satisfaction with life
as dependent variable 87
About the editors
Michel Poulain was originally trained in Astrophysics at the University of Liège

(ULg). He received a PhD in Demography at Université catholique de Louvain
(UCL). As a demographer, he specialises in Longevity studies. Currently, he is
Professor Emeritus at Université catholique de Louvain and Senior Researcher
at Tallinn University. He was the President of the Société Belge de Démographie
(1984–1990) and later of the Association Internationale des Démographes de Langue
Française (AIDELF) (1988–2000).
Involved in centenarian’s studies since 1992, he is an active member of the
International Database on Longevity (IDL) and the International Centenarian
Consortium (ICC). He validated the age of numerous supercentenarians
including Antonio Todde, Johan Riudavets and Emma Moreno, each of
whom held the Guinness Record for longevity. He also invalidated the age of
numerous others including the famous supercentenarians of the Caucasus. In
2000, he was involved in the validation of the age of the numerous centenarians
in Sardinia in cooperation with Gianni Pes, a Sardinian Medical Doctor. In this
framework, he introduced the concept of the Blue Zone when identifying an
exceptional longevity area in the mountainous part of Sardinia. The original
term Blue Zone was related to the blue pen that was used to outline the lon-
gevity area on the map of Sardinia. In two Sardinian villages, Villagrande and
Seulo, he demonstrated with colleagues an exceptional situation as men in
these villages live as long as women do, a unique situation in our modern soci-
eties. Thereafter, in cooperation with Dan Buettner and National Geographic,
he identified three other Blue Zones in Okinawa, the Nicoya Peninsula (Costa
Rica) and Ikaria (Greece). He is disseminating the lessons of the Blue Zones
to both the scientific and general public explaining that the oldest olds living
therein are models of healthy ageing for today’s society.
Jolanta Mackowicz is an associate professor (PhD with habilitation) of
Education at the Pedagogical University of Krakow in Poland. She is a researcher
in gerontological, social and educational problems issues. She has participated in
over 40 scientific conferences (at Polish and International level) and is the author
(and co-author) of over 60 publications (also indexed in JCR). Mackowicz is
x About the editors
Scholar of the Polish National Agency for Academic Exchange and Ministry
of Science and Higher Education (among others: Scientific Internship at the
University of La Laguna in Spain, study visit at University College London,
UK). She is a member of (inter)national organisations, including: International
Network for the Prevention of Elder Abuse (INPEA) –National Representative;
Stowarzyszenie Gerontologów Społecznych [Social Gerontologists Association],
Polish Academy of Sciences –Section of Gerontology. Jolanta Mackowicz also
serves as a reviewer on several international and national journals, including
International Journal of Environmental Research and Public Health, Journal of Applied
Gerontology, Sustainability, Biblioteka Gerontologii Społecznej Exlibris [Polish
Social Gerontology Journal], Pedagogika Społeczna [Social Pedagogy]. She is
an independent expert and reviewer of the European Commission Research
Programme HORIZON 2020.
About the contributors
Rosa Marina Afonso is an integrated researcher of the AgeingC group

of CINTESIS. She earned her doctoral degree in Psychology from
the University of Beira Interior (UBI) and two master’s degrees: one in
Gerontology from the University of Salamanca and the second one in Social
Psychology from the University of Porto. She graduated in Psychology from
the University of Coimbra. Currently, she works as an assistant professor
at the Department of Psychology of the UBI, where she coordinates the
master in Clinical and Health Psychology program. She has published several
scientific articles in the field of ageing.
Jesús-Adrián Alvarez’s main research interests centre on how long humans
can potentially live and the consequences of increased longevity. He is also
interested in formal demography and aspects of evolutionary biology.
Lia Araújo is an integrated researcher of the AgeingC group of CINTESIS.
She completed her doctoral degree in Biomedical Sciences at the Abel
Salazar Institute of Biomedical Sciences of the University of Porto in 2015,
with a thesis entitled “Portuguese Successful Centenarians”. Prior to that,
she had earned a master’s degree and a graduate degree in Gerontology from
the University of Aveiro. She is currently an adjunct professor at the School
of Education of the Polytechnic Institute of Viseu. She has several scien-
tific articles published in her main research areas, which include Positive
Gerontology and Centenarians.
Rotem Arieli is currently a doctoral student in Human Development and
Family Studies at Iowa State University. She serves as an associate editor for
the Journal of Critical Thought and Praxis and as the graduate student represen-
tative for the graduate education committee at her university. Her research
interests focus on social support, longevity, health personality, well-being and
successful ageing.
Caroline D. Bergeron, DrPH, is a senior policy analyst in the Division of
Aging, Seniors and Dementia at the Public Health Agency of Canada and a
member of the Ottawa Life Research Institute.
xii About the contributors
Kallol Kumar Bhattacharyya, MBBS, MA, is a medical doctor from India,

where he worked as a family physician for nearly two decades. As a mid-
life career changer, he completed his master’s degree in Gerontology from
Georgia State University, USA, and is currently researching dementia at the
School of Aging Studies, University of South Florida, USA. His research
interests include mindfulness activities to improve the quality of life of per-
sons with dementia, improvement of health policy for older adults, lon-
gevity and healthy ageing. Dr. Bhattacharyya is particularly focused on some
alternative therapeutic interventions for Alzheimer’s disease and related
dementia. He is also working on the individualised care provided in institu-
tional settings, especially nursing homes, and interested in investigating how
residents’ satisfaction levels and subsequent complaints (if any) help identify
flaws in the care delivery system.
Ewa Bryl, MD, PhD, DSc, heads the Department of Pathology and
Experimental Rheumatology at the Medical University of Gdańsk, Poland.
Her main scientific interests include cellular immunopathology: the role of
T and B cells in the pathogenesis of autoimmune diseases like rheumatoid
arthritis, systemic lupus erythematosus, Sjogren disease and autoimmune
thyroid disease and most currently the connection of intestinal micro-
biota and immune system in autoimmune diseases. Her scientific interests
include also the role of cytokines in autoimmune diseases and involvement
of NK and T cells in human ageing and the role of cytokines in this pro-
cess. Her another scientific interest is the immunoregulation by substances
isolated from different plants. To date, she co-authored 96 scientific papers
in renowned scientific journals, including Arthritis and Rheumatism, PNAS,
Blood, Journal of Immunology, Cytokine, Fitoterapia, etc., mostly on immuno-
logical aspects of rheumatic diseases and ageing, so far cited 2,595 times
(h = 24). She has promoted six PhD in medical sciences.
Tamas Fulop, MD, PhD, DSc, is Professor of Medicine and Geriatrics,
and Senior Researcher at the Research Center on Aging, University of
Sherbrooke, Québec, Canada. He is Fellow of the Canadian Academy of
Health Sciences, a member of the Graduate Immunology Programme and
a director of the Oncogeriatric Clinic. He was President of the Société
Québecoise de Gériatrie from 2007 to 2012. He has directed the Biology
Research Programme of the Research Center on Aging for more than ten
years. He obtained his MD degree at Geneva University. He received his
PhD in Biochemistry and Immunology from the Hungarian Academy of
Sciences and was a post-doctoral fellow at University Paris XII. Dr. Fulop’s
research is focused on immune response changes and mechanisms of inflam-
mation with ageing and in age-related diseases in humans. He has authored
more than 330 publications. He is recipient of the Presidential Award of
the IAGG and fellow of the GSA. He served on the executive committee
and participated in the organisation of several IAGG congresses. He served
About the contributors xiii
on the GSA Publications Committee and BS executive committee. He is

on the editorial boards of numerous journals and is the editor-in-chief of
Gerontology and Interdisciplinary Topics in Gerontology.
Yasuyuki Gondo is a professor of Osaka University Department of Human
Sciences since 2018. He began his carrier as a gerontologist when he started
working at the Tokyo Metropolitan Institute of Gerontology in 1993. He got
PhD by papers about cognitive ageing. He joined Tokyo Centenarian Study
in 1999. Since then, he interviewed more than 1,000 centenarians. He is
also an active member of the International Centenarian Study Consortium.
Anne Herm, PhD in Demography, MSc in Economy and Demography, has
made a professional career during 30 years in official statistics (Statistics
Estonia, Tallinn) of which more than 20 years on population statistics.
She also worked as a national expert for international migration statistics
in Eurostat and as a research assistant in Université catholique de Louvain
in Belgium. Since 2017 she has been working as a researcher in Tallinn
University, School of Governance, Law and Society, and has had a position as
a data developer in Tartu University. She has been participating in numerous
research and consultancy projects since last 20 years. Her expertise covers
a large range of themes in the area of population issues concerning data
and indicators for monitoring population processes. Her current research
activities focus on older people, mostly on their living arrangements and
longevity. In different areas, she has done research in international migra-
tion, mainly the consultancy and expertise in different countries, the topics
covered both regular and irregular migration.
Joseph Kim is currently a postdoctoral fellow for the Research Institute for
Studies in Education (RISE) at Iowa State University. In addition, he is an
ordained minister in the Christian Reformed Church of North America
(CRCNA). He received his PhD in human development and family studies
from Iowa State University. His research focuses on financial resources, well-
being, health personality and cognition.
Martine Lagacé, PhD, is a professor in the Department of Communication,
affiliated with the School of Psychology at the University of Ottawa and a
member of the Ottawa Life Research Institute.
Jolanta Mackowicz is an associate professor (PhD with habilitation) of
Education at the Pedagogical University of Krakow in Poland. She is also a
researcher in gerontological, social and educational problems issues. She has
participated in over 40 scientific conferences (at Polish and International
level). Mackowicz is author (and co-author) of over 60 publications (also
indexed in JCR). Scholar of the Polish National Agency for Academic
Exchange and Ministry of Science and Higher Education (among
others: Scientific Internship at the University of La Laguna in Spain, study
xiv About the contributors
visit at University College London, UK). She is a member of (inter)national

organisations, including International Network for the Prevention of Elder
Abuse (INPEA) –National Representative; Stowarzyszenie Gerontologów
Społecznych [Social Gerontologists Association], Polish Academy of
Sciences –Section of Gerontology. Reviewer on several international and
national journals, including International Journal of Environmental Research
and Public Health, Journal of Applied Gerontology, Sustainability, Polish Social
Gerontology Journal, Pedagogika Społeczna [Social Pedagogy]. Independent
expert and reviewer of the European Commission Research Programme
HORIZON 2020.
Peter Martin is Professor of Human Development and Family Studies at Iowa
State University. He received his PhD in human development and family
studies from the Pennsylvania State University and a PhD in Psychology
from the University of Bonn, Germany. His research interests include lon-
gevity, personality, stress, coping and well-being. Dr. Martin has been prin-
ciple investigator or co-investigator of the Georgia Centenarian Study, the
Iowa Centenarian Study and the Heidelberg Centenarian Study. He is one
of the co-founders of the International Centenarian Consortium. Dr. Martin
holds visiting professorships at the M. S. University of Baroda, India and the
University of Osaka, Japan.
Anthony Medford is a demographer who works in the area of mortality
and has a focus on the highest ages. He is also interested in developing
methodology and the computational aspects of the field. He is currently a
visiting researcher at the Centre on Population Dynamics at the University
of Southern Denmark.
Anna Mikosik-Roczyńska, PhD, is a researcher and her scientific special-
ties include immunology, cell biology, ageing processes, proteodynamics of
human lymphocytes. She has experience in managing and coordinating
projects in the gerontology, paediatrics, oncology, immunology and others
(including international cooperation projects and partner participation in
European scientific consortia). She was involved in research of expression
of proteins and ageing processes of immune system of young, elderly and
centenarians (e.g. comparative study of mechanism of ageing centenarians
from Poland and Italy (Sicily)). Mikosik-Roczyńska has over 10 years of
experience in research and teaching, combined with professional involve-
ment in innovative biomedical companies. She is Member of several medical
scientific societies (e.g. Polish Society of Gerontology).
Sabina Misoch is Professor, Sociologist and Head of the Institute for Ageing
Research (IAF) at the University of Applied Sciences, St. Gallen. Her
research interests include digitalisation, new technologies, AAL and robotic
solutions for elderly, identity and longevity. Sabina Misoch is a methodolo-
gist specialising in qualitative methods, especially qualitative interviewing.
About the contributors xv
She leads, among many other projects, the two largest Swiss projects on
the challenges of an ageing society (AGE-NT and AGE-INT). Since 2016
she has a close scientific exchange with Japanese researchers and cooperates
here with the University of Tokyo, Okinawa Research Center for Longevity
Science and AIST (The National Institute of Advanced Industrial Science
and Technology) in Tokyo.
Victor Molinari, PhD, ABPP (Clin), is a professor in the School of Aging
Studies at the University of South Florida (USF). He spent over 17 years
as the director of Geropsychology for the Houston Veteran Affairs Medical
Center before joining USF. He was a member of the American Psychological
Association’s Task Force on Serious Mental Illness and Severe Emotional
Disturbance, has served on APA’s Committee on Aging and has been a
member of the advisory board of NIA. He is the past national coordinator for
the Psychologists in Long Term Care (PLTC), past-president of the Society
of Clinical Geropsychology (SCG), past-president of the American Board of
Geropsychology (ABGERO) and past-chair for the Council of Professional
Geropsychology Training Programs (CoPGTP). He has published a number
of articles on mental health care in older adults and long-term care settings.
Constança Paúl is an integrated researcher of the AgeingC group of
CINTESIS at the Abel Salazar Institute of Biomedical Sciences of the
University of Porto (ICBAS-UP), where she is a full professor of Psychology
and coordinates the doctoral program on Gerontology and Geriatrics and
the 50+ Service Center (a specialised service on ageing issues). Since the
1990s, she has regularly published international and national articles and
chapters in scientific journals and books on Health Psychology and Ageing
topics.
Michel Poulain was originally trained in Astrophysics at the University of
Liège (ULg). He received a PhD in Demography at Université catholique
de Louvain (UCL). As a demographer, he specialises in Longevity studies.
Currently, he is Professor Emeritus at Université catholique de Louvain
and Senior Researcher at Tallinn University. He was the President of the
Société Belge de Démographie (1984–1990) and later of the Association
Internationale des Démographes de Langue Française (AIDELF) (1988–
2000). Involved in centenarian’s studies since 1992, he is an active
member of the International Database on Longevity (IDL) and the
International Centenarian Consortium (ICC). He validated the age of
numerous supercentenarians including Antonio Todde, Johan Riudavets
and Emma Moreno, each of whom held the Guinness Record for lon-
gevity. He also invalidated the age of numerous others including the famous
supercentenarians of the Caucasus. In 2000, he was involved in the val-
idation of the age of the numerous centenarians in Sardinia in cooper-
ation with Gianni Pes, a Sardinian Medical Doctor. In this framework, he
xvi About the contributors
introduced the concept of the Blue Zone when identifying an exceptional

longevity area in the mountainous part of Sardinia. The original term Blue
Zone was related to the blue pen that was used to outline the longevity area
on the map of Sardinia. In two Sardinian villages, Villagrande and Seulo,
he demonstrated with colleagues an exceptional situation as men in these
villages live as long as women do, a unique situation in our modern societies.
Thereafter, in cooperation with Dan Buettner and National Geographic, he
identified three other Blue Zones in Okinawa, the Nicoya Peninsula (Costa
Rica) and Ikaria (Greece). He is disseminating the lessons of the Blue Zones
to both the scientific and general public explaining that the oldest olds living
therein are models of healthy ageing for today’s society.
Oscar Ribeiro is the principal investigator of the AgeingC research group
of CINTESIS. He earned his doctoral degree in Biomedical Sciences from
the Abel Salazar Institute of Biomedical Sciences of the University of Porto
(ICBAS-UP) and his graduate degree in Psychology from the University of
Minho. Currently, he works as an assistant professor at the Department of
Education and Psychology of the University of Aveiro, where he coordinates
one of CINTESIS hubs. He is the PI of the Porto Centenarian Study
(PT100).
Ewa Sliwa, PhD, is a researcher at the Pedagogical University of Krakow in
Poland. She is pedagogist, sociologist and social therapist. She specialises
in sociology of education, sociology of the family, cultural anthropology,
social policy, interpersonal communication, intergenerational messages and
relational aspects of identity development. Her research interests focus on
biographical patterns of long-lived persons and the ability to form close
bonds and social relationships in the light of the dynamics of changes in the
modern world.
Laetitia Teixeira is an integrated researcher of the AgeingC group of
CINTESIS at the Abel Salazar Institute of Biomedical Sciences of the
University of Porto (ICBAS-UP), where she is currently an invited assistant
professor. She holds a doctoral degree in Applied Mathematics from the
University of Porto, where she had already completed a master’s degree in
Applied Statistics and Modeling and a graduate degree in Mathematics. She
has several scientific articles published in her main research areas, which
include the fields of Active Aging and Centenarians.
Jacek M. Witkowski, MD, PhD, DSc, heads the Chair and Department of
Pathophysiology at the Medical University of Gdańsk, Poland. He held
also the Presidency of the Polish Society for Fundamental and Clinical
Immunology (2017–2020) and is the Vice President of the Committee for
Immunology and Etiology of Human Infections of the Polish Academy of
Sciences (past President from 2012 to 2020). His main scientific interests
include the mechanisms of ageing of human T lymphocytes and other
About the contributors xvii
immune cells and the related mechanisms of ageing-related diseases rheuma-

toid arthritis, chronic lymphocytic leukaemia and Alzheimer’s disease. To
date, he co-authored 172 scientific papers in renowned scientific journals,
including Blood, Scientific Reports, Journal of Immunology, etc., mostly on
immunological aspects of ageing and ageing-related diseases, so far cited
5,144 times (h = 34). He has promoted seven PhD in medical sciences
and supervised three habilitations (DSc). Professor Witkowski is the member
of editorial boards of renowned international gerontology and immun-
ology journals, including Biogerontology, Current Gerontology and Geriatric
Research and Central European Journal of Immunology, and Associate Editor in
the Frontiers Aging and the Immune System, as well as reviewer for many
journals in the field. He serves also as expert evaluator of international and
national scientific projects.
Joanna Wnek-Gozdek, PhD, is a researcher at the Pedagogical University
of Krakow in Poland. She is Member of the Social Pedagogy Team at
the Pedagogical Sciences Committee of the Polish Academy of Sciences
and the Association of Social Gerontologists. She is the author of over 60
publications that present social pedagogy issues and lifelong learning. Her
research interests focus on intergenerational dialogue, life experiences of
centenarians and modern didactics.
Saori Yasumoto is an associate professor of the Department of Human
Sciences, Osaka University since 2014. She received her PhD in Sociology
from Georgia State University where she conducted various cross-national
research on family between Japan and the USA. She joined the research
team on older people, including centenarians, when she began to teach at
Osaka University. Her research interest has been always about family so that
she tries to understand centenarians in the context of family relationships.
Preface
Michel Poulain and Jolanta Mackowicz
In the context of improving longevity and global population ageing, centenarians

are emerging in growing numbers in most countries of the world. For several
decades, there has been an intense development of interdisciplinary research
on longevity in the context of realities and quality of life. Researchers from
different geographical regions try to identify the successful ageing determinants
in their studied population. Centenarians are a model of healthy and successful
ageing, and their example is important to ensure the well-being of our modern
developed societies.
This book focuses mainly on the psychosocial and educational aspects
of positive ageing; however, it also shows the perspective of different dis-
ciplines as philosophy, anthropology, demography, sociology, economics as
well as aspects related to nutrition and biological factors of longevity. It is
a collection of insights by internationally recognised researchers, who focus
their investigations on longevity determinants. Each author analyses more spe-
cifically how the results obtained can contribute improving the quality of life
of the oldest generations.
This book aims at providing the answers to these questions “what can we
learn from the centenarians, their lifestyle and their characteristics?”, that can
be a recipe for a longer, better and happier life. It is addressed to all researchers
interested in different characteristics of the centenarians, their living conditions
and their exceptionally long life and which policy implications emerge for our
ageing societies. Several chapters present case studies which describe widely the
social and individual living conditions of the centenarians in different societies
in the world. The reader will collect information to help understanding which
challenges are faced by individuals in an ageing population.The positive ageing
models based on the centenarians’ studies show how younger generations
should adapt their lifestyle to achieve a longer and happier life.
Chapter 1 discusses the examples of healthy ageing based on the data obtained
from the Blue Zone’s population (the geographical area with a high percentage
of long-lived persons). Michel Poulain and Anne Herm present examples of
xx Preface
healthy and satisfactory ageing of the long-lived individuals that might become
a unique model of healthy and happy ageing whose principles can be trans-
ferred in modern societies.
The next chapters present the patterns of the course of life of the oldest
people from different perspectives. In Chapter 2, Saori Yasumoto and Yasuyuki
Gondo discuss the gap between the realities of everyday life as seen by the
centenarians and the image of centenarians shared by the younger age groups,
thus, emphasising the social role of the centenarians in the ageing Japanese
society. In Chapter 3, Jolanta Mackowicz, Joanna Wnek-Gozdek and Ewa Sliwa
focus on the relatively rarely addressed axiological aspects of longevity, namely,
the messages of teachers who reached 100 to younger generations, delivered
through generational transmission.
The next three chapters (4–6) present the results of research focusing on the
psychological aspects of life of the centenarians.The authors investigated factors
that optimise the quality of life in the old age. In Chapter 4, Martine Lagacé and
Caroline D. Bergeron present their study using life-story narratives, exploring
the personality traits and resilience in a group of Canadian centenarians. In
Chapter 5, Sabina Misoch presents the results of her research into psychosocial
determinants of long and healthy life. Chapter 6, authored by the Portuguese
researchers, Laetitia Teixeira, Lia Araújo, Rosa Marina Afonso, Constança Paúl
and Oscar Ribeiro, discusses factors connected with life satisfaction, emphasising
the role of a psychological sphere in longevity.
In Chapter 7, Jacek M. Witkowski, Ewa Bryl, Anna Mikosik-Roczyńska and
Tamas Fulop describe the meaning of biological factors in the context of life
of the centenarians. They answer the question how can the biological processes
change with age and whether age-related changes can be slowed down to
improve the quality of life in terms of function span and well-being of the
oldest olds.
Kallol Kumar Bhattacharyya and Victor Molinari discuss in Chapter 8 the
impact of health, cultural and social determinants on longevity in the context
of traditional lifestyle in India. At present, India is the second most populated
country in the world. Using their philosophy, yoga and diet may help our
Western ageing societies.
In Chapter 9, Anthony Medford and Jesús-Adrián Álvarez investigate the
longevity dynamics, pointing out that increasing longevity is experienced by
a selected group of individuals who enjoy greater functionality and are more
independent in their daily activities.
Peter Martin, Rotem Arieli and Joseph Kim discuss in Chapter 10 the
role of community support for centenarians and describe how such support
influences the psychophysical health of this oldest age group and the quality
of their life.
newgenprepdf
Preface xxi
Chapter 11 provides an overview of viewpoints included in each chapter

presenting implications for ageing societies. To address the initial question on
what can we learn from centenarians that might contribute to live longer and
better in an ageing society, we consider successively the individual, social and
educational aspects of that question.The closing section Chapter 12 is the coda
with final reflections.
Chapter 1
Blue Zone
A model to live longer and better
Michel Poulain and Anne Herm
Introduction
Researchers have always taken a keen interest in centenarians, and extreme
longevity is a favourite theme for the general public through the media. As
early as 1558, Cornaro considered centenarians as examples of healthy ageing.
Interest in centenarians increased in the 18th century, as shown in Luxdorph’s
Gallery of Long-Livers (Petersen and Jeune 1999). Nevertheless, the extreme ages
of the centenarians mentioned in these works, most of them over 120 years
old, have never been questioned by their authors. According to Laslett (1999),
neither Bacon, in 1638, nor Locke, in 1661, or even Harvey, in 1669, explicitly
addressed the issue of age validation. The Belgian statistician Quételet, who
was probably the first to suspect the existence of false centenarians, launched
a systematic validation process for the 31 centenarians counted in the 1846
census (Poulain, Chambre and Foulon 1999). By checking the birth dates with
local governments, he found that only 21 of them were actually centenarians.
Thoms’ (1873) work marked a definite turning point in the interest to validate
exceptional human ages. His proposed method was based on checking the con-
sistency of information collected in the baptism, marriage and death registers
of individuals, as well as other biographical information. At the end of the
20th century, a growing scepticism emerged among demographers concerning
validating the ages of an increasing number of ‘supercentenarians’ (Jeune and
Vaupel 1999). Therefore, a set of strict rules for verifying extreme ages have
been developed by researchers managing the international database on lon-
gevity (Poulain 2010). In this framework, the exceptional age of the first two
documented supercentenarians, Geert Boomgaard from Groningen and Anne
Neve Harvey from the island of Guernsey, has been thoroughly investigated
(Mayer, Jeune and Vaupel 2020).
Individual versus population longevity

Since Cornaro, the search for the factors explaining the extreme longevity and
so-called centenarians’ secret has been the subject of investigation for researchers
DOI: 10.4324/9 781003162216-1

2 Michel Poulain and Anne Herm
(Robine 2010). Scientists regard centenarians as examples of healthy ageing

(Engberg et al. 2009).The search for the determinants of longevity is carried out
from an interdisciplinary perspective, involving gerontologists, demographers,
geneticists, nutritionists, psychologists, sociologists, anthropologists, environ-
mental specialists, etc. Exceptional longevity has generally been studied at the
individual level by considering the case of each particular centenarian sep-
arately. Among the best-known studies are the Georgia Centenarian Study
(Poon et al. 1992) and the New England Centenarian Survey1 in the United
States, the Centenarian Study in Sweden (Samuelsson et al. 1997) and Denmark
(Andersen-Ranberg and Jeune 2001), as well as the Okinawa Centenarian
Study2 and the Tokyo Centenarian Study in Japan (Arai et al. 2015). Articles
examining the impact of different factors of longevity are regularly published
in scientific journals (Christensen and Vaupel 1996; Montesanto et al. 2012;
Passarino, De Rango and Montesanto 2016), but given the complexity of the
phenomenon, there is still a long way to go in discovering the keys to what
some call the fountain of youth or the secret of the centenarians.
The existence of longest-lived populations was not considered by researchers
until the second part of the 20th century, when explorers discovered sev-
eral remote regions where the inhabitants showed exceptional longevity.
For example, in the January 1973 issue of National Geographic, the physician
Alexander Leaf describes his travels to countries where people are reported
to live exceptionally long lives: the Hunza in Pakistan, the Abkhazians in the
Soviet Union and the inhabitants of Vilcabamba in Ecuador. According to Leaf,
there were ten times as many centenarians in these places compared to most
Western countries, despite a context characterised by poor hygiene, infectious
diseases, high infant mortality, illiteracy, and a lack of modern medical care (Leaf
1973). Nevertheless, a few years later, Mazess and Forman (1979) demonstrated
that age misreporting was predominant in Vilcabamba, due to the tendency
for the elderly to exaggerate their age to improve their social status, or more
generally, to promote local tourism, a reality later recognised by Leaf (1981).
On a global scale, careful checks of all available documents, interviews and stat-
istical data were carried out, leading to the conclusion that all the longevity
populations identified in the 1970s were invalidated. Perls summarised it as the
following: ‘several geographical areas have made claims of extreme longevity,
but upon closer examination these claims have proved to be false and such cases
of extreme longevity require further examination as they are incredibly rare’
(Perls et al. 2002, p.359). Like the validation of individual centenarians, valid-
ating the extreme longevity of a population requires a number of specific steps
of investigation, which vary between countries according to the availability of
data sources for these populations. For example, an exhaustive registration of
births a century ago is needed, as well as information on living centenarians and
the deaths of centenarians during recent decades.
In 1999, at a meeting in Montpellier, the Sardinian medical researcher Dr. Pes
presented the results of a study that asseverated the extreme longevity of men
Blue Zone 3
in Sardinia (Deiana et al. 1999). However, demographers were sceptical of his

conclusion, and in order to check this statement, a task force to assess the val-
idity of the assumed ages of the oldest people in Sardinia was called. On the
basis of a strict validation method, the ages of Sardinian centenarians have been
carefully checked and found to be valid (Poulain et al. 2006). Unexpectedly, the
validation of the individual ages of the centenarians was not the only signifi-
cant result of this survey. After the individual validation of each centenarian’s
age, links were established between the number of centenarians born in each
village and the total number of new-borns born in the same village at the time
of their birth. This indicator of longevity, known as the Extreme Longevity
Index, corresponds to the probability of reaching the age of 100 years for the
new-borns at a certain place of birth. The spatial distribution of this indicator
gave a completely different result from the first results published previously by
the centenarians’ geographical place of residence. A specific area of exceptional
longevity that emerged in the mountainous region of Ogliastra in Sardinia is
called a Blue Zone because the validation team used a blue pen to delimit the
area of longevity on the map of Sardinia in March 2000. Since then, a Blue
Zone has been conceptually defined as ‘a rather limited and homogeneous geo-
graphical area where the population shares the same lifestyle and environment,
and where its longevity has proven to be exceptionally high’ (Poulain, Herm
and Pes 2013).
In 2001, soon after the identification of the Sardinian Blue Zone, a validation
process was also initiated in Okinawa, where the population was widely known
for its longevity (Willcox,Willcox and Suzuki 2001).The results of this exercise
confirmed that people in Okinawa were indeed long-living, and the status of
Blue Zone could be attributed to it as well (Poulain 2011). In 2005, Buettner,
an American journalist, published an article in National Geographic comparing
the populations of these two exceptional longevity areas with a long-living
Adventist community in Loma Linda, California (Buettner 2005). In close col-
laboration with Buettner, and following Rosero-Bixby’s (2008) research on
nonagenarians in Costa Rica, a field study was initiated to identify a third
Blue Zone on the Nicoya Peninsula. An attempt to identify a new Blue Zone
in Peru was abandoned because there were no reliable data to prove the exact
age of the alleged centenarians. It was in Greece then, more specifically on the
mountainous island of Ikaria, that the fourth Blue Zone was identified in a
population consisting barely of 8,000 people who remained outside the tourist
roads (Poulain and Pes 2009).
The longevity of a population in a specific geographical area, summarised by
the concept of the Blue Zone, is complementary to the individual longevity of
centenarians. The determinants of longevity can be more easily identified when
studying the population distinguished by exceptional longevity as a whole, in order
to pinpoint its specific features. These can be a specific diet, the level of physical
activity, a particular type of occupation or strong community relationships. The
chances of finding explicable variables for longevity are higher in a Blue Zone,
Spatial distribution of centenarians in Sardinia.

Figure 1.1
Left: Crude distribution by place of residence (Deiana et al. 1999).
Right: Smoothed distribution by place of birth adjusted for birth cohort size (Poulain et al. 2004).
as most inhabitants have a number of similar features. They are usually genetically
close to each other, have experienced the same living conditions since childhood,
share the same traditions and local diet, consume the same local products, and
live in the same physical and social environment. All of these factors enable the
analysis to eliminate the ones that vary between centenarians from different geo-
graphical areas and at the same time identify common features existing in all
populations with remarkable longevity. Possible explanations that support living
a longer life by many people in a population can be found in a Blue Zone.
These populations live on islands and/or in mountainous regions that are geo-
graphically and/or historically isolated and less polluted. They have managed to
maintain a largely traditional lifestyle that is characterised by reduced stress levels,
intense family and community support for the older members, and consumption
of locally produced food. They are also characterised by intense physical activity
even at higher ages, for example, beyond the age of 80. The latter is consistent
Blue Zone 5
Figure 1.2 Geographical location of the Blue Zone in Ogliastra, Ikaria, Nicoya peninsula,
and Okinawa (Poulain, Herm and Pes 2013).
with the results of studies that support the positive association between increased
physical activity levels, participation in exercise, and improved health in older
people (Pes et al. 2018). It is likely that these conditions limit the accumulation
of factors having a negative impact on health, in contrast to the western world.
In the Blue Zone populations, a remarkably good health status at older ages
may be a result of a delicate balance between the benefits of modernity, such
as increased wealth and better medical care, and of the traditional lifestyle. The
above-mentioned factors together may have favoured an ideal environment for
the emergence of long-lived phenotypes at the population level. The study of
the populations identified as living in a Blue Zone could therefore help to better
understand the causal factors of longevity.
The comparison of the four Blue Zones

Among the environmental factors assumed to be favourable for longevity, the
four Blue Zones are characterised by altitude and terrain variability, with the
exception of the island of Okinawa, which is not particularly mountainous.
Living in an environment where the large differences in altitude demand phys-
ical effort on a daily basis is a favourable factor for better health, including for
the elderly. Based on Sardinian data from local communities, the steeper the
slope on average, the more energy is consumed during working life, which
could result in a longer lifespan (Pes et al. 2018). The natural physical environ-
ment may also contribute in other ways, e.g. better air and water quality, which
potentially impact health and longevity.
From a historical viewpoint, the relative isolation of each Blue Zone may
be associated with specific behaviours related to nutrition and activity. All Blue
Zone populations, including Okinawa, maintain rather traditional lifestyles,
which maintain a strong link between its inhabitants and the natural environ-
ment, contributing to these populations’ higher longevities. However, nothing
has been proven at this stage of research, and there are many other isolated areas
where traditional life continues, but the populations do not experience excep-
tional longevity.
In addition, other factors may play a considerable role, such as the impact
of genetic composition (Perls, Kunkel and Puca 2002), which remains largely
unknown, as does endogamy. Diet, although very different in all four Blue
Zones, reveals a common feature: the consumption of local products or a diet
that is not derived from industrially produced food. However, the average cal-
oric consumption by the Blue Zone’s populations, with the notable exception
of Okinawa, is not different from that of the general population of the country.
Therefore, the hypothesis on the favourable role of caloric restriction on lon-
gevity, as suggested by Fontana, Partridge, and Longo (2010), cannot be proved
in the Blue Zone’s populations. Of course, it is theoretically plausible that the
quality of the food rather than the quantity supports in maintaining excellent
health among these populations.
The level of physical activity should also be considered among the factors
associated with longevity. In a Blue Zone, active engagement in work often
ends after age 80, and the continuation of a relatively high level of physical
activity is considered a normal part of life even at older ages. The absence of
stress and the low prevalence of depression and dementia have been observed
in all Blue Zones, as well as the importance of strong family ties and close social
relationships within the community. These provide an undeniable support that
can contribute to greater longevity. Factors that are often negatively associated
with longevity, such as smoking, obesity, alcohol consumption, and the preva-
lence of suicide, show great differences between the four Blue Zones.
The search for common determinants of longevity in the four Blue Zones
has only begun. Quantitative and qualitative surveys can be further developed
Blue Zone 7
in a comparative manner, involving biomedical and behavioural aspects, and

considering the analysis of individual lives from an anthropological perspec-
tive. The main aim of these surveys will be to understand how the different
transitions experienced by the communities (fertility, epidemiology, educa-
tion, communication, nutrition among others) may have interacted to result in
exceptional longevity.
The genetic and epigenetic components play a role in explaining why a
person can reach 100 years, but no specific gene or epigenetic trait has been
identified so far that similarly characterise the Blue Zone’s populations. In par-
ticular, the study of DNA methylation in historically or geographically isolated
populations such as in a Blue Zone may prove useful. These populations have
been exposed to high levels of endogamy and have therefore gradually and sig-
nificantly reduced their genetic diversity.
Despite numerous investigations developed to date, no overarching explan-
ation for the Blue Zone’s exceptional longevity has been found. Up to now,
only some favourable factors have been identified. Nevertheless, there are
numerous populations on the earth with similar characteristics that do not
express such longevity. Accordingly, further research is necessary.
Transferring the Blue Zone’s lessons

Much research is still needed in order to unlock the secrets of longevity, but
beyond the specific nature of this quest, there is a paradox worth exploring.
In certain populations, such as on the Nicoya Peninsula in Costa Rica, on the
islands of Ikaria and Okinawa, and in the mountains of Sardinia, exceptional
longevity is significantly more remarkable than in most developed societies
with state-of-the-art health systems. Why, in economically and technologically
developed populations, do so many deaths between the ages of 60 and 80 occur,
that should be preventable with the support of an efficient health system? In
a Blue Zone that is not as highly developed, women and men often live well
into their 90s. Could the lessons learned from investigating the determinants of
Blue Zone’s longevity help to answer this question? Appel (2008) expressed the
idea that ‘blue zones, now limited to a few populations around the world, can
become commonplace’. Still, the question is how the lessons learned from the
four Blue Zones can be transposed to improve healthy ageing in post-industrial
societies. This question led Buettner to launch the Blue Zones Project,3 aimed
at creating a community-level program in the United States to help improve
the health and well-being of its inhabitants. The originality of this project is
that it does not address the individuals directly, but rather proposes a systemic
approach that allows citizens, schools, employers, restaurants, and grocery shops
to work together with community leaders on policies and programs that will
have the greatest impact on the health status and well-being of all citizens.
The Blue Zone’s community project aims at making and spontaneous indi-
vidual choices that promote healthy living more accessible. Concrete actions
supporting sustainable changes in the wider environment of these communities

are developed and accordingly encourage people to make better choices for
their health and well-being in their daily lives. Initial results on the ground are
encouraging, as Wolfe (2012) noted that
Blue Zones have an impact on the way people eat and exercise, on how
they find new ways to build communities and get to know each other, on
how they reduce smoking zones and increase opportunities for altruism –
all key elements in creating a Blue Zone community.
In Europe, similar initiatives are being developed in the Netherlands (Jansen

2017). For example, the Healthy Aging Network Northern Netherlands (HANNN)
project aims to support the population to age in good health by following the
principles of Blue Zone.4 The ambition of the HANNN project is to create
the favourable longevity circumstances, observed in the four Blue Zones, in
their own society. To this end, this project has opted for a lifelong approach.
According to its slogan, healthy ageing takes a lifetime and does not only start
at the age of 65. This project is supported by scientists from the University
of Groningen, who have developed a detailed approach for the implementa-
tion of a ‘Man-Made Blue Zone’ in order to stimulate the development of a
quality of life similar to those observed in a Blue Zone.5 To achieve this, it is
not only a question of improving health care but also of developing a more
ecological environment and a healthier lifestyle by promoting physical exercise
and optimising nutrition and social networks. The underlying idea is that an
approach based on the principles of the Blue Zone can offer a solution to health
care bottlenecks and improve the quality of life. The idea is not to propose a
copy of the existing Blue Zones, but rather a prototypical version that considers
local specificities. Therefore, the success of a Man-Made Blue Zone requires a
good understanding of the local area, the characteristics of its residents, and
their living conditions in order to expect significant improvements in health
and well-being indicators. The project includes a set of interventions aimed at
facilitating social engagement and stimulating people’s life purpose through,
among other things, a set of interventions that encourage physical activity and
contribute to a healthier diet. Local community initiatives that come from the
citizens themselves are essential to providing abroad support for this initiative.
In addition, it is important that local actors are broadly involved in the project;
a general practitioner, a neighbourhood sports coach, or a village scholar, for
example, are key players. These community members can provide much more
effective support than any initiative or directive from outside. Strong resilience
emerges within these communities due to mutual dependence, and the shared
belief in the promise of the project creates a strong bond.
The above-mentioned initiatives are developed in the line of principles
emerging from our observations on living in a Blue Zone (see Box 1.1). In the
past, these principles existed in traditional societies, but the rules of healthy and
Blue Zone 9
Box 1.1 The seven principles of living in a Blue Zone

Through the analysis of in-depth surveys on lifestyle and behaviour
involving many centenarians in a Blue Zone, seven major principles have
been identified which, combined with as yet unknown genetic factors,
may account for the exceptional longevity of these populations. These
principles can be transferred to other societies in order to promote better
health and a longer life.
The first principle is ‘move naturally’. The Blue Zone’s elders are
constantly moving as they do their daily activities. De facto retirement
occurs often after age 80 years, and the reduction in physical activity
adapts to the gradual reduction in physical capacity. Activity in the vege-
table garden, olive groves, vineyard, or in animal husbandry are parts of
daily life.The daily distances travelled by the Blue Zone’s elders’ everyday
lives are astonishing, especially after factoring in the differences in altitude
due to the steep relief of the villages. Although fitness rooms allow active
moving and physical activity, the key message is the following: move nat-
urally, without excess but with endurance.
The second principle is ‘eat wisely’. Eating is a vital need for the body,
and the amount of food needed depends largely on the energy expended
in physical activities. However, as learned from the people living in a Blue
Zone, it is advisable to stop eating when the stomach is 80% full. Eating
too much does not contribute to health and longevity. Even if the table
prepared in the families of the elders is attractive and varied, none of the
elders commit a sin by surfeit. In a Blue Zone, fruit and vegetables are
locally produced and seasonally consumed, comprising a healthy diet that
does not rely on the food industry, which promotes trade and small local
producers.
The third principle is to ‘avoid stress and get plenty of sleep’.
Stress is omnipresent in daily life in modern western societies. Among
the people of a Blue Zone stress is almost absent. A sufficient period of
daily rest is also indispensable for living long and healthy. Old people in a
Blue Zone follow the diurnal cycle of the sun –going to sleep early and
also getting up early. Without a doubt, a healthy lifestyle is conducive to
longevity, as the Blue Zone’s people teach us.
The fourth principle is to ‘keep strong family ties’. In each Blue
Zone, the importance of the family stands out.With the notorious excep-
tion of Okinawa, families cannot imagine separating from their elderly,
even dependent ones, by transferring them into nursing homes. Among
the Blue Zone’s populations, family solidarity and the ties that unite the
members of even an extended family are essential. If an elderly person
lives alone, a family member often lives nearby. Other seniors share their
lives with several of their children, and family celebrations are frequent.
The fifth principle is to ‘stimulate strong community support’.

The sense of solidarity goes far beyond the family.The elders in each Blue
Zone are honoured, maintaining their essential place in each village com-
munity. The community celebrates centenarians, frequently organising
festivals for exceptional longevity, which bring together the entire local
community.
The sixth principle is ‘respect for the planet’. In each Blue Zone,
ecological concern and respect for the planet are omnipresent, even if the
terms ‘ecology’ or ‘bio’ are hardly ever used. No preservatives, additives,
or flavour enhancers are used to disrupt the flavour and taste quality of
locally produced food. These habits are ancestral and rooted in tradition.
The seventh principle is ‘having a purpose in life’. Older people
living in a Blue Zone enjoy their life, and each day brings them a new
impulse. In each Blue Zone, some leitmotif exists which expresses this
optimistic view on life: ‘Pura Vida’ in Nicoya Peninsula, ‘Akent’annos’,
which means ‘may you live up to a hundred years old’ in Ogliastra;
‘Ikigai’, which includes an intense feeling of happiness, and has a positive
connotation towards a goal, in Okinawa; whereas, in Ikaria, being com-
munist does not contradict being religious. The belief in the existence of
a superior being is particularly strong among the centenarians, who see it
as the main reason for their exceptional longevity.
natural living have largely deteriorated during the processes of industrialisation

and excessive urbanisation. Past populations did not live as long as observed
today. They did not have recourse to the progress of modern medicine and
techniques that make it possible to cure diseases that were then considered
incurable. Nowadays, improved medical services are counterbalanced by the less
healthy lifestyle of industrialised societies. Therefore, reconsidering the basic
principles of a natural and simple life, following the example of Blue Zone’s
elders, has become a must.
The Blue Zone and the well-b eing of the older

The Blue Zone’s lessons are aimed towards all ages, but in ageing societies,
which tend to exclude older people from the active social life, the experi-
ence of Blue Zone’s populations is helpful for their reintegration. Even though
the principles of the life in a Blue Zone and the need for promoting healthy
ageing are increasingly recognised by all generations, the situation of the elderly
still needs to be addressed more attentively. For example, the living conditions
chosen, or sometimes imposed, for a growing number of seniors are among the
concerns (Coughlin 2017). A common question for an ageing person is:‘Where
Blue Zone 11
do I want to live as I get older?’ In general, as people age, they prefer to stay
where they have their home, with all their personal possessions and memories,
but also their social contacts. They want to remain independent and free to
make their own choices as long as possible. Whereas ageing at home allows the
preservation of their social environment, it usually requires certain external
support and housing adaptations in line with increasing dependency, due to
the deterioration of physical and cognitive abilities. The assistance provided at
home by any close person or geriatric nurse ensures that the support is effective
in case of partial loss of independence. Nevertheless, some characteristics of the
living environment may appear to be inappropriate, and in some cases, it will
be necessary for the elderly person to move away from home. For example, a
family dwelling might be too large for an old couple or for an alone-living
elderly. In such a situation, a smaller dwelling would better suit to the needs of
an older person. Moreover, living at home in old age is becoming increasingly
more synonymous for living alone, a situation that might impact the well-
being of the person, including a higher risk of poor physical and mental health
(Courtin and Knapp 2017).
Another choice would be living in a child’s household. This choice was
widespread in past traditional societies and is still predominant among the Blue
Zone’s populations. However, in current societies, it often proves to be unfeas-
ible or even unimaginable for practical reasons such as a lack of space in the
children’s accommodation or the physical distance from the children’s home.
Moreover, studies have shown that most of the elderly prefer to live in their
own homes (Treas and Bengtson 1987) or prefer alternative solutions to living
with their children, including institutionalisation.
With increasing age, the most observed option –not to say choice –is
living in a collective household. These residential facilities usually provide a
range of care solutions and services. Today, traditional nursing homes are the
still prevalent collective living arrangements for the elderly. Although they are
often perceived negatively, nursing homes are necessary for solving problems
linked to the rapid increase of the elderly population. But the question remains
whether the creation of additional nursing home places provides the solution
for escalating ageing population. Other various types of nursing and residen-
tial facilities for the elderly have emerged recently, and there is certainly room
for new developments. Whereas people entering nursing homes nowadays are
older and more dependent than they were a couple of decades ago (Poulain
and Herm 2016), the need for care is not the only reason. Living in a nursing
home is often chosen for security reasons as well as a solution against loneliness.
Being part of a mutually supportive community has a positive impact on health
status, social connection, and life quality. Contemporary society does not offer
friendly places for older people where they can feel integrated in the com-
munity, such as those observed in a Blue Zone. Therefore, alternatives to trad-
itional nursing homes should be developed. Proposing a vision of a living area
for the elderly that integrate services and social links is the objective of a few
environmental architects, some of whom considered the Blue Zone’s principles

as the target for their visions.
Among the various initiatives, the senior co-housing communities are the result
of adapting the modern community living movement to older people. The
first senior co-housing communities were established in Denmark in 1987
(Jaffe 1989).This concept offers a model of independent living for older people
which is very different from what is offered in nursing homes or other resi-
dential care homes. The dedicated space includes both private dwellings and
common facilities, and it is designed specifically for a community of older
people. The design of the place and the appropriateness of the dwellings are
important because often the layout of the surroundings and the characteristics
of the dwellings tend to isolate people, limit their interactions, and thus dis-
courage the creation of a neighbourhood atmosphere. Senior co-housing commu-
nities, on the other hand, help to combat isolation and leave the choices to the
residents. They are generally small, and are planned, developed, and managed
by the residents themselves. The general idea is to promote community, social
involvement, and active ageing. This community- based approach to inde-
pendent living restores the advantages of traditional villages similar to the ones
in a Blue Zone in a contemporary context and helps to maintain the integra-
tion of older people in the society. On the other hand, for those reaching older
ages, it can provide the conditions for a relative ‘social disengagement’ in line
with the gerotranscendence theory of ageing (Tornstam 2005).
Senior co-housing communities bring together people who choose to live
in cooperation on the basis of common values that are articulated according to
a commonly agreed community vision. The choice of living in a community
is not only accessible to seniors but also to residents of all ages. Comprehensive
planning for post-active life is not limited to health and wealth; it is a matter of
preparing to live longer, certainly, but above all better in terms of well-being.
Considering the active, dynamic, and neighbourly lifestyles that these com-
munities can provide, this approach is also of interest to younger people, thus
ensuring an intergenerational cohabitation that takes inspiration from trad-
itional lifestyles as in a Blue Zone.
Innovative experiences in Belgium

In Belgium, two recent ongoing initiatives are in line with the senior co-housing
communities, and the idea behind their development refers to the seven Blue
Zone’s principles. These are the ‘Blue Zone’s Flanders’ project6 and the ‘Jardin des
Paraboles’, with its leitmotif ‘Living Blue Zone’.7
Triamant, one of the leading innovators in residential care in Flanders, creates
residential neighbourhoods that, according to their slogan, ‘add life to the years
and not just years to life’. With four neighbourhoods already in operation and
two under construction in Flanders,Triamant wants to contribute to improving
the quality of life of the elderly by following the seven principles of the life in
Blue Zone 13
a Blue Zone. The goal is to promote the autonomy of the residents, contribute
to their vitality, offer integrated care when necessary, and create bonds of soli-
darity between people. Triamant combines the main advantages of traditional
forms of housing within dynamic neighbourhoods. These give residents the
feeling that they have their own home, with the added benefit of solidarity
and access to round-the-clock care, as in a residential care complex. The entire
infrastructure is accessible for people with reduced mobility. Just as in a nursing
home, residents receive individual attention and all the care they need. People
with a dependent partner can also continue to live together there, while a mix
of generations is favoured in the four Triamant neighbourhoods.
The Jardin des Paraboles is a housing project developed by the Promactif Group
in an abandoned satellite telecommunication area in Southern Belgium. This
project involves the creation of a new village infrastructure that provides all the
necessary services for people with different needs, including the elderly. The
infrastructure also includes a comfortable living environment and accommoda-
tion for people with reduced mobility and space for intergenerational contacts.
The promoter wants to build the project in the spirit of Living Blue Zone
and to facilitate ageing and the well-being of the elderly. Infrastructure should
create the conditions for easier and spontaneous lifestyles for all residents of the
community. Such an innovative project provides an opportunity to apply the
seven principles of living in a Blue Zone to practice in the community.
Conclusion
Introducing the concept of Blue Zone of longevity encouraged the search for
the determinants of extreme longevity. This complements the results obtained
in numerous studies of individual longevity that consider the characteristics of
the centenarians around the world. The diverse factors that may explain lon-
gevity are interactive, and thus the final explanation for the extreme longevity
of centenarians can be found at the crossroads of various disciplines. However,
to date, the way different factors interact in the phenomenon of the exceptional
longevity in Blue Zone’s populations is still unknown, in spite of numerous
scientific investigations. Nevertheless, the Blue Zone lifestyle has become an
important example for policy implications in public health and for the pursuit
of individual well-being, especially in the Netherlands. Most of these com-
munity projects are developed with the direct involvement of the scientific
researchers who initiated the concept of Blue Zone. It represents an excellent
example of applying the results of scientific research in policy support.
Western societies tend to count out the elderly as soon as they become
dependent. No longer useful for the society, they are often placed into nursing
homes, among similar vulnerable fellow human beings, waiting for death.Today
there exist an urgent need to reintegrate these senior citizens into society to
enable them to maintain intense intergenerational relationships. Seniors around
the world have just an expectation to enjoy life, retain their social usefulness, and
maintain a purpose in life, like the ones observed in a Blue Zone. The energy
that the Blue Zone’s centenarians have, and their respect for a simple and nat-
ural life are essential values to be revived in the individualistic and materialistic
societies where most of the elderly in Europe live today. The love expressed
by the Blue Zone’s elders for life and for their fellow human beings cannot
be confined to the four Blue Zones. Their message is particularly relevant in
the context of the 2020 COVID-19 pandemic. The impact of the pandemic
on vulnerable populations, particularly the elderly living in nursing homes, has
been eye opening and challenging. Not only are the figures staggering, but evi-
dence shows that the physical and social environments where the elderly are left
to die are inhumane (Estabrooks et al. 2020).
Paradoxically, the COVID-19 pandemic provides a unique opportunity to
reassess our lifestyle. The principles of a Blue Zone are even more relevant now
than in ‘normal’ times and can be used as a tool to change the communality and
promote the sustainability of nowadays’ society. In spite of confinement and social
distancing, these difficult times have led to an unexpectedly increased sense of soli-
darity and social closeness. Nursing homes have paid a heavy price during the pan-
demic. While this sector is slowly recovering from the shock, it is time to rethink
the models for better supporting seniors.The first and foremost need is to change
the vision about the old age and the perception of elderly peoples’ abilities and
needs. The principles of a Blue Zone are an option of choice for all generations
among the population. It seems particularly important to reassess the ways of
caring for elderly people. The health crisis risks reinforcing the negative image
of traditional care structures perceived as a vector of vulnerability in the event of
an epidemic. The initiatives underway in the United States, the Netherlands, and
Belgium foresee that the elderly will contribute more in decisions about their
living environment.These initiatives aim to provide the older population a chance
to live longer in good health and with the purpose of life in an atmosphere of
simple and natural well-being in the line observed in a Blue Zone.
Notes
1 www.bumc.bu.edu/centenarian/.
2 www.okicent.org.
3 https://info.bluezonesproject.com/home.
4 www.hannn.eu/.
5 www.rug.nl/cpheb/docs/koertvanittersum.pdf.
6 www.bluezonesflanders.com.
7 www.jardindesparaboles.
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Concluding remarks and

reflections
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World Health Organization (2020) Decade of healthy ageing baseline report, Geneva: WHO.

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Positive Ageing and Learning

Michel Poulain is Professor Emeritus at Université catholique de Louvain,

Jolanta Mackowicz is Associate Professor at the Pedagogical University of

Perspectives on Behavioural Interventions in Palliative and

Perspectives on Palliative and End-​of-​Life Care

New Developments in Dementia Prevention Research

For more information about the series, please visit: www.routledge.com/​

Living Longer and Better

List of figures vii

1 Blue Zone: a model to live longer and better 1

2 Impact of aging society on expectations of aging self in

3 Intergenerational transmission of values of Polish

4 Exceptional longevity: exploring personality factors and

5 Ikigai: meaning of life and other psychosocial factors

6 Life satisfaction and survival in centenarians 75

7 Longevity and the role of biological factors in the context

8 Longevity: cultural and social influences of a unique

9 A closer look at life expectancy among cohorts of Danish

10 Environmental support among centenarians 138

11 Implications for ageing society 153

12 Concluding remarks and reflections 164

1 .1 Spatial distribution of centenarians in Sardinia 4

3 .1 Characteristics of studied cases 33

Michel Poulain was originally trained in Astrophysics at the University of Liège

Rosa Marina Afonso is an integrated researcher of the AgeingC group

Kallol Kumar Bhattacharyya, MBBS, MA, is a medical doctor from India,

on the GSA Publications Committee and BS executive committee. He is

visit at University College London, UK). She is a member of (inter)national

introduced the concept of the Blue Zone when identifying an exceptional

immune cells and the related mechanisms of ageing-​related diseases rheuma-

In the context of improving longevity and global population ageing, centenarians

Chapter 11 provides an overview of viewpoints included in each chapter

Individual versus population longevity

DOI: 10.4324/​9 781003162216-1

(Robine 2010). Scientists regard centenarians as examples of healthy ageing

in Sardinia (Deiana et al. 1999). However, demographers were sceptical of his

Spatial distribution of centenarians in Sardinia.

The comparison of the four Blue Zones

in a comparative manner, involving biomedical and behavioural aspects, and

Transferring the Blue Zone’s lessons

supporting sustainable changes in the wider environment of these communities

In Europe, similar initiatives are being developed in the Netherlands (Jansen

Box 1.1 The seven principles of living in a Blue Zone

The fifth principle is to ‘stimulate strong community support’.

natural living have largely deteriorated during the processes of industrialisation

The Blue Zone and the well-​b eing of the older

environmental architects, some of whom considered the Blue Zone’s principles

Innovative experiences in Belgium

Longevity and the role of

A closer look at life

Environmental support among

Concluding remarks and

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immune cells and the related mechanisms of ageing-related diseases rheuma-

DOI: 10.4324/9 781003162216-1

The Blue Zone and the well-b eing of the older