Why count years if they're not good?
The discussion about longevity has become popular: more years on the birth certificate is presented as the goal in itself. But I also see the flip side: years of multimorbidity, loss of function and social isolation.
So it makes sense to shift the focus from how long we can keep a heart beating to how well that heart - and the people around it - actually live. Gerontologists call this the healthspan: the total years of life in which the patient is physically, cognitively and socially functional.
As a practitioner, I would argue that the patient's years of function and happiness - healthspan and happyspan - should be our primary goal, not just the raw number of years.Longevity - what does it really mean?
Longevity - what does it really mean?
Longevity simply describes how long a person can statistically be expected to live. It measures advances in medical treatment, hygiene and nutrition that have significantly increased average life expectancy over the past 150 years.
Longevity research often zooms in on genetics, molecular repair mechanisms and new pharmaceuticals that can delay the biological wear and tear of age. It's fascinating - and potentially revolutionary - because even a modest increase in cell 'lifespan' can translate into extra calendar years at the population level.
The challenge arises when the number on the statistic becomes an end in itself: More years without a simultaneous focus on functional ability and enjoyment of life can end up shifting the burden of disease rather than reducing it.
Life years, healthspan and happyspan
The table below compares the three concepts at their core clinical points, so both doctor and patient can quickly see if the conversation is about prolonging life itself, increasing years of function - or ensuring as many years of health and happiness as possible.
| Concept |
Clinical definition |
Relevance in general practice |
| Lifetime |
Number of years from birth to death |
Provides demographic insights but says nothing about quality of life |
| Healthspan |
The years of life without major disease burden and loss of function |
Matching patients' goals to maintain independence |
| Happyspan |
The years lived in good health and experiencing joy, community and meaning |
Focusing on subjective well-being and motivating change |
Five key pieces of medical advice
When patients ask where to start, I often point to five simple focus areas. They require no fancy gadgets - just small, consistent choices in everyday life.
1) Stable blood sugar and strong muscles
Move daily, eat vegetables, whole grains and protein - you'll maintain weight and energy better.
2) Suppress silent inflammation
Go to bed early and get 7-8 hours of sleep, avoid smoking, de-stress with breathing or walking, and choose olive oil, fish and vegetables on your plate.
3) Keep your brain working
Read a book, learn a new word, play a game or talk to someone - it keeps your memory sharp.
4) Cultivate community
Spend time with friends and family, join a team or club - loneliness takes its toll more than many people think.
5) Find your "why"
Make room for the activities and people that give you meaning and joy, and cut back on the things that drain your mood.
Choose one piece of advice at a time, make it a daily habit and gradually build on it. Small steps make the biggest difference in both healthspan and happiness over time.
When death reminds us to live
When we recognize that life is finite, our clinical decisions are sharpened. The conversation about treatment intensity for an 87-year-old with severe dementia only makes sense when we talk about what makes sense for the patient - not just another year in a nursing home.
In practice, the question "What would a good day be for you?" guide both treatment goals and deprescribing strategies. This shifts the conversation from survival to quality of life.
Put quality of life at the center
Ultimately, it is the patient's perceived quality of life that determines whether a treatment or prevention program is successful. A long life without the ability to manage daily tasks, participate in social communities or feel joy does not satisfy patients, families or society.
Therefore, all clinical decisions - from medication selection to referral for rehabilitation - should be filtered through the question: "Does this improve a person's ability to live an active, independent and meaningful life?"
When we consistently apply the "quality of life glasses", we prioritize not just years on paper, but good days on the calendar. This focused perspective motivates both patient and practitioner to make the lasting changes that really matter.
From healthspan to happyspan
When the healthspan is extended, the next question arises: How long can the joy of life keep up? What good are flexible knees if the soul has stiffened? Therefore, we must also talk about happyspan - the years when robustness is accompanied by curiosity, togetherness and laughter.
As practitioners, we can shift the focus from chronometer to compass: helping people towards more years that feel like lives, not just counted.
