About a decade ago, I saw a 74 year-old female as a new patient. Aside from mild back pain, her examination was great. I remember after taking her blood pressure and pulse, I shared her readings and kiddingly said, “Your readings are great and you’ll probably live another 20 years.” She replied, “I hope not.” I was taken back. “Why not?, I asked.” She replied that she will run out of money. That reply still sits with me today. It’s still fresh in my mind, especially because my goal is to reach 110.
I spend my days helping people optimize their health. We talk about metabolic markers, hormone balance, gut health, inflammation – all the things that move the needle on how well your body ages. And I believe in that work deeply.
But recently, something made me pause. Again!
MIT AgeLab, in collaboration with John Hancock, just released what they’re calling the Longevity Preparedness Index, a first-of-its-kind tool that measures how ready people actually are to live longer lives. Not just biologically. Not just financially. But across the full spectrum of what a longer life demands.
They surveyed over 1,300 adults and measured preparedness across eight domains: health, finance, care, home, daily activities, social connection, community, and life transitions.
The average score? 60 out of 100. A D grade. I scored a 72. Great- a low C. Not that great.
That stopped me. Because here we are in the golden age of wellness content – supplements, biohacking, longevity podcasts – and people are still fundamentally unprepared for the lives they’re trying to extend.
The Gaps We Don’t Talk About
The lowest-scoring areas were care, home, and health. Most people don’t know who will care for them as they age. They haven’t considered whether their home will work for them at 80. And despite all the information available, they haven’t put real health systems in place, not just intentions, but actual structures.
Care was the biggest blind spot. Think about that. People are investing in their retirement accounts but have never once had a conversation about who shows up when they can’t drive themselves to an appointment. Or who helps them recover after a surgery. Or what happens if their spouse, the person they assumed would always be there – can’t be.
These aren’t edge cases. These are probabilities. And most of us are treating them like they’ll never happen.
Why This Matters to Me as a Functional Medicine Doctor
As a Functional Medicine practitioner, I’ve always championed healthspan over lifespan. The idea that it’s not about living longer on medications – it’s about thriving. But this index forced me to ask a harder question: even if we get the biology right, are we ready for the rest of it?
I think about a patient I worked with a few years ago. Mid-sixties, metabolically healthy, great labs, exercising regularly. On paper, she was winning. But her husband had just passed, her kids lived across the country, and she’d moved into a home with stairs she was already struggling with. She had no local community. No plan for care. No daily structure beyond the routine her marriage had provided.
Her biology was optimized. Her life was not.
That’s the gap this index is measuring. And it’s the gap I think we need to start addressing – not just as individuals, but as a healthcare community.
Biology Doesn’t Exist in a Vacuum
Here’s what I know from years of practice: loneliness raises cortisol. Financial stress drives inflammation. Loss of purpose accelerates cognitive decline. Poor sleep – often driven by anxiety about the future – unravels metabolic health. The “non-medical” domains in this index aren’t separate from health. They’re deeply intertwined with it.
If I optimize your labs but you have no social connection, no community, no plan for care, and no financial safety net — I haven’t actually helped you live a longer, better life. I’ve helped you live a longer, potentially fragile one.
Dr. Joseph Coughlin, Director of MIT AgeLab, puts it well. He describes preparedness not as a checklist but as an active process: awareness of what lies ahead, assessment of how realistic our assumptions are, and action to put systems in place before we need them. Planning is just a grocery list, he says. Preparedness is what actually puts food on the table.
I think that framing should change how all of us – patients and providers approach the conversation about aging.
The Challenge
So here’s what I want to leave you with. Look at those eight domains – health, finance, care, home, daily activities, social connection, community, life transitions – and be honest with yourself. Where are you solid? Where are you exposed?
Have you had the hard conversations with your family about care? About housing? About what your days look like when work is no longer the centerpiece? About what happens when life throws a curveball you didn’t budget for – emotionally or financially?
You don’t need perfect answers today. But you need to start. Because living longer without being ready for it isn’t a victory- it’s a vulnerability.
Let’s expand what longevity means. Beyond the labs. Beyond the bank account. Into the full, messy, beautiful reality of a life that lasts.
Start the conversation. Start it now. Because the years are coming whether we’re ready or not – and I’d rather we meet them prepared.
Sources: MIT AgeLab — “The Longevity Preparedness Index: Measuring What It Takes to Live Longer, Better” by Joseph F. Coughlin, PhD. A4M Blog — “Longevity Preparedness: A New Metric for a Longer-Living Population.”
