What a geriatrician says actually protects healthy aging

Longevity science has become a crowded, expensive corner of wellness culture, full of promises about the latest compound that will add a decade to your life. Dr. Deborah Kado, a geriatrician and gerontologist at Stanford, argues that the conversation that actually matters is much less glamorous, and far more actionable, than most of what gets clicks.

Health span versus healthy longevity

Kado deliberately avoids the popular term "health span" because of how it frames chronic illness. If someone develops rheumatoid arthritis at 40, does that mean their health span is over? She prefers "healthy longevity" instead, a framing that allows someone to manage a chronic condition and still live a long, meaningful life rather than being defined by a diagnosis. This distinction shapes how she treats patients: the goal is not the absence of disease but functional independence, especially the ability to keep living in one's own home.

Power, not just strength, prevents falls

One of the more overlooked findings in aging research is that fast-twitch muscle fibers, the ones responsible for quick bursts of force, decline disproportionately with age. Kado's own research used force plates to separate raw strength from power, the combination of strength and speed, and found power to be the more meaningful variable for functional outcomes. Slow, controlled resistance training builds strength, but reactive, quicker movements are what let someone catch themselves during a trip before it becomes a fracture. Activities that combine coordination, balance, and memory, such as dancing, showed particularly strong associations with healthy aging in her clinical experience, alongside tennis and playing a wind instrument for its added respiratory benefits.

The real story on bone medications

Bisphosphonates, the first FDA-approved osteoporosis drugs, saw a dramatic drop in use after 2008 media coverage linked long-term use to rare atypical thigh fractures and jaw osteonecrosis. Kado puts the actual numbers in context: jaw complications occur in roughly 1 in 1,000 people receiving cancer-level doses, versus estimates as low as 1 in 100,000 at standard osteoporosis doses, and the risk is manageable with routine dental care. Despite the scare, multiple randomized trials show bisphosphonates cut fracture risk by about 50 percent.

Newer options work differently. Romosozumab, sold as Evenity, most closely mimics the bone-building effect of exercise and reduced both vertebral and hip fractures in trials. Denosumab, sold as Prolia, is a twice-yearly injection that blocks bone resorption, but stopping it triggers a rebound increase in fracture risk unless it is followed by another therapy. Anabolic drugs like teriparatide build bone through daily injections but are typically limited to about two years of use.

Why deprescribing matters

Kado has treated patients on dozens of supplements and medications simultaneously, a pattern linked in observational studies to worse health outcomes overall. She has taken patients off bisphosphonates after a decade of use once their fall risk and bone density stabilize, and routinely reviews whether older sedatives, particularly benzodiazepine-based sleep aids and long-term proton pump inhibitors, are still necessary given their links to fall risk, cognitive decline, and impaired nutrient absorption.

Nutrition, microbiome, and unexpected connections

Kado's research on the gut microbiome found that plant diversity, not any specific diet label, predicted the richest microbiomes, with roughly 40 different plants per week associated with the greatest diversity in one large study. In her own research on older men, those with more diverse gut bacteria had higher levels of the active form of vitamin D, and separately, men with the most consistent sleep and wake times had the most diverse microbiomes. She also cautions against BMI-based judgments in older adults: population data suggests an optimal BMI near 27 for older adults, and being underweight is a stronger risk factor than being overweight.

Attitude toward aging predicts dementia risk

A Yale study by psychologist Becca Levy, using decades of data from the Baltimore Longitudinal Study of Aging, found something striking: people who reported more positive attitudes about aging in their 30s had a 50 percent lower risk of developing dementia decades later, an effect seen both in carriers and non-carriers of the APOE E4 genetic risk variant. Kado sees the same pattern clinically with her oldest patients, many of whom stay engaged, treat their brain like a muscle that needs regular challenge, and avoid framing themselves by a diagnosis or a birthday.

Practical takeaways

• Prioritize quick, reactive movement and balance work alongside standard strength training to reduce fall risk.
• If you or a family member has taken a bisphosphonate for over a decade, ask your doctor about reassessing the need to continue.
• Review long-term use of sleep medications and acid reflux drugs periodically, since both carry risks that compound with age.
• Aim for a wide variety of plant foods across the week rather than following a specific named diet.
• Treat consistent sleep and wake times as part of a gut-health strategy, not just a sleep strategy.

The bottom line

Kado's clinical experience points to a consistent theme: the people who age best are rarely chasing the newest compound. They stay physically active in ways that challenge power and balance, question medications that may no longer serve them, eat a varied plant-forward diet, and keep engaging with something that gives them purpose. None of it is flashy, but the evidence behind it is much stronger than most of what dominates the longevity conversation.