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Invited Commentary |

Thriving of the Fittest:  Comment on “Fitness and the Development of Chronic Conditions in Later Life”

Diane E. Bild, MD, MPH
Arch Intern Med. 2012;172(17):1340-1341. doi:10.1001/archinternmed.2012.3406.
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In 1980, James F. Fries, MD, published his seminal thesis on the limit of the average human life span—which he pinpointed at 85 years—and the compression morbidity into the final period of life, which he offered as both observation of a societal trend and a public health goal.1 He whimsically invoked this ideal by citing a poem by Oliver Wendell Holmes Sr about a “one-hoss shay,” a carefully constructed carriage that functions beautifully and then breaks down “to pieces all at once” after exactly 100 years. Fries contrasts this vision to the notion that ever-increasing life span afforded by improvements in public health and medicine would lead to increasing proportions of the population spending many of their final years with significant infirmity. Fries and his colleagues2 have continued to find evidence for the compression of morbidity and the “rectangularization” of the survival curve.

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