Dr. Levine is a nationally recognized expert in wound care and pressure ulceration. and has published and spoken widely on this topic. He is a Board Member of the National Pressure Ulcer Advisory Panel (NPUAP). Dr. Levine's Pocket Guide to Pressure Ulcers co-authored by Elizabeth Ayello RN and published by the New Jersey Hospital Association is in its 4th printing and has sold over 30,000 copies.

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I heard so much about the Blue Zone phenomenon that I went to check it out for myself. “Blue Zone” is the proposed name for a geographic area with large numbers of healthy elders. Advocates for this concept say they can reveal secrets for a longer, more productive life. Identified locations include Okinawa, Sardinia, certain towns in Costa Rica and Greece, and Loma Linda, California. Loma Linda was easiest for me to get to, so I set out from Los Angeles in my rented car to explore this small sun-drenched town in the San Bernadino Valley.

Loma Linda was founded by the Seventh Day Adventist Church, and members comprise 40% of residents. They believe that a combination of faith, community, and diet make for longer lives. Members of the Church do not smoke, drink, gamble, or eat meat, and they avoid soft drinks and coffee. This was one of the groups that Blue Zone author and explorer David Beuttner studied in support of the Blue Zone phenomenon.

After an hour and a half drive, I exited the I-10 freeway and headed to the Loma Linda Senior Center, where I met with Joanne Heilman, Executive Assistant to the City Manager and director of the Senior Center. I asked her whether she believes that Loma Linda is truly a “Blue Zone” where people live longer lives. She responded enthusiastically that the city is a healthy place to live, with city-sponsored workshops that promote longevity through exercise, culture, and nutrition. I learned from an attendee at the Center that the only bar in town closed about five years ago.

I observed a painting class taught by renowned artist and Viet Nam veteran David Fairrington. He told me how important his class was to the older attendees. “It gets people out,” he said, “and it’s a great form of socialization.” One of David’s students told me how much his class helped her after a serious illness. “It’s been wonderful,” she said.

I then drove to the Loma Linda Market — the biggest all-vegetarian store I have ever seen. They had a huge variety of grains sold in bulk, and all types of meat substitutes. While there I met and photographed a Korean-American couple who were married for 40 years, and expressed affection for each other and life in the San Bernadino Valley.

I stopped at the Linda Valley Villa, an assisted living facility where I chatted with Evelyn Heath, a spry 99 year-old Seventh Day Adventist who walks to church every Saturday. Evelyn spent her life on a farm tending to children, grandchildren, and great-grandchildren. I asked her how she lived so long and she replied, “I have no idea, I didn’t plan it this way.”


The Blue Zone concept was popularized by National Geographic, Oprah, and Dr. Oz. But does it present an accurate view of aging, or does it reinforce cultural myths that deny the realities of illness, disability, and death?

According to author Susan Jacoby, our culture markets a false concept of aging that ends where the most disabling and restrictive stages of aging begins. We are taught by popular media that a longer, healthier life is possible through good behavior, supplements and drugs. Thus the Blue Zone niche: celebrating healthy old age while ignoring disability and chronic illness. This short-sighted view reinforces American mythology surrounding growing old, and believing it justifies the lack of attention to the medical specialty of geriatrics.

In the coming decades nearly 78 million people from the Woodstock Generation will enter the geriatric age group. They will be more educated regarding medical issues at a time when geriatrics is under-taught in many medical schools, and the number of geriatric specialists is shrinking. They will be demanding detailed explanations about pills and illnesses as more and more graduates of American medical schools shun primary care. Some predict that the result will overwhelm our healthcare system.

There is no doubt that exercise, proper dietary choices, and staying connected with family and community can lead to longer and healthier lives. But the reality is that most Americans who live beyond age 85 will die after a period of mental or physical disability, and half of those will spend time in a nursing home. Elderly people are frequently not educated about the consequences of aggressive medical interventions and end-of-life care by a profession that has neither the time nor the training to deliver this information.

I had a great time in Loma Linda and met some very interesting people. I have no doubt that California sunshine, exercise, art, and good nutrition (along with the right chromosomes) can help achieve longer and more productive lives. But life style factors and medical advances have not eliminated chronic disease, physical disability, and dementia. The fact remains that our health care system is unprepared for the demographics of the new old age.

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Related blog posts:

How Will Health Care Reform Affect Geriatrics?
Retooling for an Aging America: The Thud That Should Have Been a Bang
Aging Across America Goes to Sturgis
Aging Across America Visits a California Shopping Mall

For references on topics discussed in this post see the following:

What Are We Going To Do With Dad? An essay by Jerald Winakur MD
Never Say Die: The Myth and Marketing of the New Old Age, a book by Susan Jacoby





  • 01/08/2015, 6:03 pm  Reply

    I enjoyed the article but it misses the point of Blue Zones. I did not assert that disability and diseases in not and issue. The Premise of my National Geographic article and Blue Zones book is this: Most of what determines how long we live is dictated by our lifestyle and environment. I found five areas where people are living measurable longer and tired to identify the factors. The longevity phenomena in Loma Linda is ONLY among observant Seventh Day Adventists who live between 7-10 years longer that their California counterparts.

    At any rate, I’m appreciate the interest in my work.

  • Robert E Roush
    09/24/2012, 1:15 pm  Reply

    Well said, Jeffrey. Your point about the right chromosomes is the key: epigenetics is teaching us that poor lifestyle choices can adversely affect our DNA. Whether more “correct” dietary and other choices make a difference is yet to be seen. Those 10,000/per day turning age 65 will learn soon enough. Hopefully there will be more medical doctors like you around to help them. At this juncture, that’s problematic.

    Were I “president for a day” I’d offer capitation grants for medical residents who choose geriatrics – wipe out their student debt, make Medicare reimbursement more realistic for those who care for frail elders, etc., especially for the added time to do it right; give each practice at least one geriatric nurse practitioner, social worker, and geropharmacist, perhaps even an exercise physiologist to lead resistance weight training classes. Always good to read and see your important work. Cordially, Bob

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Dr. Jeffrey M. Levine has authored numerous articles on topics related to healthcare of the elderly. These include medical history, prevention and treatment of chronic wounds such as pressure ulcers, elder neglect and abuse, and physical restraints. He has also edited a book on legal and regulatory aspects of nursing homes.