Why count years if they aren't good?
The discussion about longevity has become popular: more years on the birth certificate are presented as the goal in itself. But I also see the downside: years with multimorbidity, loss of functional level and social isolation.
Therefore, it makes sense to shift the focus from how long we can keep a heart going to how well that heart – and the person around it – actually lives. Gerontologists call this healthspan: the total years of life in which the patient is physically, cognitively, and socially well-functioning.
As a general practitioner, I would argue that the patient's many years of functional capacity and joy – 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. The term measures advances in medical treatment, hygiene and nutrition, which over the past 150 years have significantly raised the average life expectancy.
Longevity research often focuses on genetics, molecular repair mechanisms, and new drugs that can delay the biological wear and tear of aging. It's fascinating – and potentially revolutionary – because even a modest extension of cells' '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.
Lifespan, healthspan and happyspan
The table below compares the three concepts based on their core clinical aspects, allowing both doctor and patient to quickly assess whether the conversation is about extending life itself, increasing the years of functional capacity, or ensuring as many years as possible with both health and happiness.
| Concept |
Clinical definition |
Relevance in general practice |
| Lifespan |
The number of years from birth to death |
Provides demographic insight but says nothing about quality of life |
| Healthspan |
The years lived without major disease burden and loss of function |
Matches patients' goals of maintaining independence |
| Happyspan |
The years lived with both good health and experienced joy, community and meaning |
Focuses on subjective well-being and motivates change |
Five important pieces of medical advice
When patients ask where they should specifically start, I often point to five simple focus areas. They require no advanced gadgets – only small, consistent choices in everyday life.
1) Stable blood sugar and strong muscles
Move daily, eat vegetables, whole grains, and protein - this will help you maintain weight and energy better.
2) Reduce silent inflammation
Go to bed early and get 7-8 hours of sleep, avoid smoking, de-stress with breathing or walks, and choose olive oil, fish and greens on your plate.
3) Keep your brain active
Read a book, learn a new word, play a game, or talk to someone – it keeps your memory sharp.
4) Nurture the community
Spend time with friends and family, join a team or a club – loneliness is more damaging than many people think.
5) Find your "why"
Make room for the activities and people that give you meaning and joy, and cut down on what drains 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 acknowledge that life is finite, our clinical decisions become more focused. The discussion about the intensity of treatment for an 87-year-old with severe dementia only makes sense when we talk about what creates meaning for the patient – not just about another year in a nursing home.
In practice, the question "What would a good day be like for you?" can guide both treatment goals and deprescribing strategies. It elevates the conversation from survival to quality of life.
Focus on quality of life
Ultimately, the patient's perceived quality of life determines whether a treatment or prevention course is successful. A long life without the ability to cope with daily tasks, participate in social communities, or feel joy does not satisfy the patient, relatives, or society.
Therefore, all clinical decisions – from the choice of medication to referral for rehabilitation – should be filtered through the question: “Does this improve the person's ability to live an active, independent, and meaningful life?”
When we consistently apply the 'quality of life' lens, we prioritize not only years on paper but good days on the calendar. This focused perspective motivates both the patient and the healthcare professional to make the lasting changes that truly make a difference.
From healthspan to happyspan
When 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 general practitioners, we can shift the focus from chronometer to compass: helping people towards more years that feel like life, and not just counted.
