Abstract
Successful aging is a dynamic process shaped by genetic, environmental, and lifestyle factors that influence health and well-being across the lifespan. Pioneering researchers such as Dr. Ruth Lawrence have demonstrated how intentional choices in diet, physical activity, social engagement, and mental resilience contribute to longevity and quality of life. This review explores the concept of successful aging, tracing its origins in the groundbreaking work of Havighurst, Rowe, and Kahn, and incorporating insights from Dr. George Vaillant’s longitudinal studies, including the Harvard Study of Adult Development and the Grant Study. These works highlight the profound impact of psychosocial factors, adaptability, and meaningful relationships in fostering vitality and emotional fulfillment throughout life. Drawing on evidence from meta-analyses, centenarian studies, and landmark intervention trials such as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, this review examines how modifiable lifestyle factors influence aging trajectories. It also discusses emerging research linking maternal behaviors—such as breastfeeding—to long-term health benefits, including reduced risks of chronic diseases and cognitive decline. Dr. Lawrence’s extraordinary century-long life exemplifies these principles, showcasing the interplay of genetics, lifestyle, and purpose in achieving successful aging. By synthesizing existing research and honoring Dr. Lawrence’s legacy, this article highlights the importance of integrative approaches to aging well. It advocates for holistic strategies that combine individual health behaviors, community support, and systemic policy changes to promote longevity and health span. Dr. Lawrence’s contributions to breastfeeding medicine and her embodiment of the six pillars of lifestyle medicine—nutrition, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections—serve as a testament to the power of lifestyle in shaping vibrant, fulfilling lives. Her example inspires a vision of aging as an opportunity for growth, connection, and continued impact.
Introduction
Dr. Ruth A. Lawrence exemplifies successful aging: what has been her secret? As background, Dr. Lawrence (affectionately known as “Ruthie” by her family) has lived a healthy life and belongs to an elite group of centurions, having crossed the 100-year line of life. In an interview with her oldest son, Robert “Rob” M. Lawrence, MD, Rob shared many aspects of Ruth’s life that she and her family ascribe to her longevity. Rob shared that diet was essential to Ruth and that she ate a balanced and healthy diet throughout her life. She would have a small breakfast, a smaller lunch, and then a nutritious dinner that she always cooked—homemade foods were the norm. While Ruth did not work out at the gym, exercise was important to her: Ruth exercised by walking everywhere every day, including taking the stairs instead of the elevator.
Essential to Dr. Lawrence was family and a small group of close friends. According to her son, “She always had your back, no matter who you were.” Family was everything to Ruth. She considered her mentees part of her extended family. She included everyone and wanted to share her knowledge in this way. She had a diverse group of close friends, including college friend Rod Sterling from the Twilight Zone. She was great friends with Audrey Naylor, MD, a pioneer in breastfeeding medicine and the cofounder of the Academy of Breastfeeding Medicine and the journal Breastfeeding Medicine with Ruth. She became close friends with Karla Shephard Rubinger, PhD, an executive at the publisher Mary Ann Liebert, Inc., and included her as part of the “family.”
Probably the most salient feature—Dr. Lawrence always had mental engagement and a sense of purpose. Her faith and religious devotion were her “guiding lights.” As a proponent of the importance of breastfeeding as essential to the newborn and infant, as it set the stage for lifelong, optimal health and well-being, Dr. Lawrence helped formalize the field of breastfeeding medicine. It was her astute mind, medical background, and her personal experiences in breastfeeding each of her nine children (including when she was the sole pediatric female house officer at the Yale-Grace New Haven Hospital and when there were no pumping rooms or storage facilities specific for her breast milk) that gave her the necessary drive and personal insight to change the status quo surrounding breastfeeding. She met the challenge and accomplished the seemingly impossible—breastfeeding and working full-time.
So important was Dr. Lawrence’s realization of the importance of breastfeeding and its role in health care and medicine that she wrote nine editions of her textbook entitled, Breastfeeding: A Guide for the Medical Professional. The first edition was published in 1980, 1 and each edition was read in many countries worldwide, serving as the leading authority on breastfeeding medicine for health care professionals. Most strikingly, the 9th edition was published when she was 97 years old (published in 2022). 2
During the interview with Dr. Lawrence’s oldest son, Rob, coauthor of the last several editions of the breastfeeding textbook, shared that with each edition after it was published, Ruth would reread her textbook and annotate it with questions and would seek out answers in preparation for the next edition of the textbook. Each edition chronicled the journey of Dr. Ruth Lawrence and the growth of the field of breastfeeding medicine. She went on to cofound the Academy of Breastfeeding Medicine when she was 70, at a time in life when many adults are “winding down.” Her family always said she would “die with her boots on.”
Longevity is evident in Dr. Lawrence’s family: she has an older sister who is over 100 years old. She had two other siblings, one of whom (a sister) died in a car accident, and her brother died at the age of 82. She drank wine occasionally and never smoked. According to those close to her, sleep was not one of her best lifestyle pillars. She was typically the first to rise and the last to be in bed because she had nine children and worked full-time. She spent her life in a relatively low-pollutant environment, growing up in upstate NY, training in Yale/New Haven, and then returning to Rochester, NY. These remarkable accomplishments combined with excellent physical and mental health demonstrate yet another accomplishment: Dr. Lawrence is what the literature describes as a “successful ager.” Given this reality, this article will address two issues: How has Ruth’s lifestyle contributed to her successful aging, and what does the literature tell us about the aging process?
Successful aging
The concept of successful aging emerged in gerontology and psychology in the 1960s and 1970s. Havighurst 3 was one of the first theorists to propose the idea of successful aging, defining it as “getting satisfaction from life.” Havighurst, in 1961, introduced the idea that aging could be positively experienced and that older adults could achieve high satisfaction in life by staying active and involved in meaningful activities.
Successful aging gained traction in the 1980s and 1990s, mainly due to the influential work of John Rowe and Robert Kahn, 4 who challenged traditional beliefs that equated aging with inevitable decline. These authors identified three core components of successful aging: avoiding disease and disability, maintaining high cognitive and physical function, and continuing active engagement, all of which Dr. Lawrence has demonstrated during her lifetime. These ideas were groundbreaking at the time because they offered a framework that challenged the typical view that aging was a time of decline, introducing a model where positive lifestyle choices could lead to healthier, more fulfilling later years. Examples of current textbooks widely used in the field include the Handbook of the Psychology of Aging), 5 now in its 7th edition or Aging Well: Surprising Guideposts to a Happier Life, based on data from the Landmark Harvard Study of Adult Development, 6 one of the longest-running studies on aging.
The concept of successful aging, then, emerged from the prevailing stereotype that aging was inevitably associated with increasing mental and physical disability to the modern-day understanding that aging not only involves living longer but can include a proactive lifestyle that maintains physical, cognitive, and emotional well-being while actively participating in life. 7 Thus, the term aligns with an optimistic view of aging, highlighting adaptability, health, and a satisfying quality of life as people grow older.
Centurions
Insights into successful aging have come from studies showing commonalities between centurions. These studies on aging have shown that centenarians often share several lifestyle factors, genetic predispositions, and health habits. While reaching 100 is not solely dependent on any factor, some commonalities exemplified by Dr. Lawrence are observed among people who live this long.
Some key findings from the 2012 New England Centenarian Project (founded in 1994) 8 have shown that centenarians often have a genetic profile that protects them against age-related diseases. Specific genes linked to longevity include variations in the APOE and FOXO3 genes. Many centenarians in this cohort did not suffer from common age-related diseases (such as heart disease, diabetes, and Alzheimer’s) until well past 80 or 90 years of age, suggesting that longevity is often linked to a delayed onset of disease rather than simply avoiding it altogether. In this cohort, many centenarians also exhibited certain psychological traits, such as resilience, optimism, and managing stress effectively. This certainly is the case with Dr. Lawrence as well.
Common findings across similar studies (see Okinawa Centenarian Study, 9 Sardinian Centenarian Study, 10 The Italian Study on Centenarians and Semisupercentenarians, 11 and the Longitudinal Study of Aging Danish Twins 12 ) show that centenarians often follow diets rich in plant-based foods, high in fruits, vegetables, whole grains, legumes, and healthy fats.13,14 Many centenarians follow dietary patterns outlined in the Mediterranean or Okinawan diets, which are low in red meat and refined sugars with moderate or minimal alcohol intake. Regular, moderate physical activity is a staple of centenarians, whether walking, gardening, or light exercise. Both a healthful diet and consistent physical activity were key factors in Dr. Lawrence’s daily living.
How about the effect of breastfeeding itself on longevity? As we have seen, Dr. Ruth Lawrence, a trailblazer in breastfeeding medicine and a centenarian, embodies the concept of successful aging. Her personal experience of breastfeeding nine children, accumulating a remarkable 9 years of breastfeeding, aligns with growing scientific evidence on the health benefits of lactation. A recent study of 166,708 U.S. nurses found that longer cumulative breastfeeding durations were associated with reduced all-cause mortality, including significant decreases in deaths from cardiovascular disease and cancer. 15 Women who breastfed for 7–11 months, 12–23 months, and 24 months or more experienced mortality risk reductions of approximately 6%–7% compared with those who breastfed for 3 months or less. Dr. Lawrence’s century-long life exemplifies the benefits suggested by such findings and underscores her role in advancing knowledge and advocacy for maternal and child health.
Long-term cognitive benefits are associated not only with the recipient breastfeeding infant but also with the mother. A 2021 study by Fox et al. highlights the long-term cognitive benefits of breastfeeding for women. 16 Analyzing a sample of women aged 50 and older in Southern California, researchers found that those who breastfed demonstrated significantly superior performance in cognitive domains such as learning, delayed recall, executive functioning, and processing speed compared with those who did not. These benefits persisted even when accounting for factors such as age, education, and ethnicity and were observed among both nondepressed and parous women. Although depressed women who had breastfed also showed improved executive functioning and processing speed, the overall effects suggest that breastfeeding may contribute to brain health in later life. The findings align with the broader health benefits of breastfeeding, including reduced risks of type 2 diabetes, cardiovascular disease, and breast cancer, and suggest evolutionary advantages for maternal cognitive competence in environments where breastfeeding was more common. Relevant to Dr. Lawrence, with more than 9 cumulative years of breastfeeding, she demonstrated superior performance in cognitive domains longitudinally with no chronic illnesses noted.
Social connections with strong social ties are often linked to longer lives, and many centenarians, including Dr. Lawrence, have been found to have close-knit family and community relationships, giving them a strong sense of purpose and support. Solid social connections help reduce stress, which may contribute to better health outcomes in centenarians over time.17–20
Centenarians often display psychological resilience, a positive outlook, and an ability to manage stress. Practices such as meditation, prayer, or simply maintaining an optimistic mindset are common findings that seem beneficial in helping one deal with life’s challenges. A sense of purpose and a “reason to get up in the morning” are common themes among centenarians. Dr. Lawrence exhibited a deep sense of faith and commitment to serving others and had a keen sense of purpose through her global community involvement, family, hobbies, and personal goals.
Expectedly low rates of chronic disease are typical in centenarians as they have typically avoided chronic diseases until much later in life, possibly due to genetic resilience and lifestyle factors. Moderate eating habits of many centenarians include some form of mild or mindful eating. This might consist of eating smaller portions or not eating until “full.” Examples come from the Okinawan principle of “hara hachi bu,” which involves eating until about 80% complete. Certainly, Dr. Lawrence ascribed to this practice.
Consistent sleep patterns and sufficient rest are common among centenarians. They often maintain a regular sleep schedule and get enough restorative sleep each night. 21 Many centenarians also live in less polluted areas with clean air and water, which might reduce environmental stress on their bodies. As mentiuoned earlier, Dr. Lawrence’s son shared that Ruth was the first to rise and the last to go to bed, working full-time and having nine children, with perhaps less sleep than some, but consistent sleep.
Insights on the process of aging have shaped attitudes toward aging, public health recommendations, and intervention strategies that promote healthy aging. Aging studies underscore that aging outcomes are shaped by a complex interplay of genetics, lifestyle, social factors, and environment, highlighting the importance of holistic strategies to support health, independence, and well-being throughout the lifespan. Dr. Lawrence is a strong case to this point.
A role model for successful living
A measure of Dr. Lawerence’s success is her academic medical practice, which has no doubt had a vast and unquantifiable impact on the world through her care of her patients, scholarly publications, lectures, and mentees who have likewise mentored their students. As outlined in this article, Dr. Lawrence’s lifestyle and philosophy, in evidence throughout her century, exemplify the importance of the six pillars of health in adult lifestyle medicine. Dr. Lawrence is, by all accounts, an exemplifying successful “ager” and a role model for all within and beyond her highly specialized career in breastfeeding medicine, something to which all of us should aspire.
Footnotes
Acknowledgment
The authors thank Robert M. Lawrence, MD, for his time and willingness to share aspects of Dr. Ruth Lawrence’s personal and family history and his insights into successful aging.
Author Disclosure Statement
No interests to disclose.
Funding Information
No funding was received for this article.