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Living at the Height of Health

Adrienne Saia Isaac

Nov. 1, 2018 -- Ken Willoughby and Doris Spencer may have discovered the Fountain of Youth -- in the Rocky Mountains of Colorado.

He's 80 and she's 72, yet they regularly climb the nation's highest mountains, more than 14,000 feet above sea level, where the air is thin, the weather is severe, and little grows. In winter, when other people are sleeping in until the ski area chairlifts open, they're skiing uphill in the predawn cold, with sticky layers called skins on their skis to gain traction on the snow, nearly 7 days a week, 135 days last winter.

"The mountains are a big draw for Doris and I. We love to summit. We like the challenge, and we've been pretty good for it at our age," says Willoughby. "It's healthy. It's fitness. It's cardiovascular. It's tremendous, and we just do it all the time."

But if you think this couple is an anomaly, performing feats of fitness that would put most people half their ages to shame, think again. They live in Colorado's Summit County, a mountainous region that a recent study found has the highest average lifespan in the U.S.: 86.83 years. By contrast, the lowest average lifespan was in South Dakota's Oglala Lakota County, with an average lifespan of 20 years less: 66.81.

The study identified things like social and economic standing, race, ethnicity, quality of health care, and behavioral patterns as the main drivers of life expectancy. The key risks were identified as diabetes, high blood pressure, lack of exercise, obesity, and tobacco use.

Summit County is a stunningly beautiful mountain playground, which attracts well-off retirees, day-trippers, and weekend skiers from Denver, 70 miles to the east, and seasonal waves of young people who come from all over the world with a dream of living the ski bum life. But there are lots of mountain resort communities across the country, and Colorado as a whole is particularly fit, with the lowest obesity rate in the nation. What makes folks here so healthy?

We ventured into the heart of the Rocky Mountains this summer to find out.

Population Boom

Like most people who live in Summit County, Willoughby and Spencer aren't from here. A retired school superintendent from New Orleans, he moved here in the early 1990s, as did Spencer, who retired from an aerospace company.

They moved here for the same reason most people do: the skiing. They met in a club for older skiers.

Summit County, hemmed in by mountains on all sides, was once a prosperous mining community, but the decline of the mines meant that by the 1960s, the area was a desolate backwater. Two things happened that changed that: Interstate 70 finally reached the county via the new Eisenhower Tunnel beneath the Continental Divide in 1968, meaning drivers from Denver no longer had to brave treacherous mountain passes.

And big skiing came to Summit County. Breckenridge Ski Resort opened in 1961, followed by resorts Keystone and Copper Mountain. The area's original ski resort, Arapahoe Basin, had existed since the 1940s but catered mostly to locals.

With skiing came people. The county's population grew from 2,665 to 8,848 in the 1970s; to 12,881 by 1990; 23,548 by 2000; and 28,000 in 2010.

Many first came here as tourists, like Carol Faust, an Illinois resident. She and her husband bought their first condo here in 1989.

"When we retired, we just kept spending more time here and less in Illinois, and we said, 'This is stupid, going back and forth,’ so we just moved out here, " says Faust, 81, during her shift volunteering at the Summit County Senior Center.

She spends much of her time hiking in the mountains in summer and snowshoeing in winter. Her husband still downhill skis at 85. The retirees here, she believes, are a different breed than those elsewhere.

"I think the seniors are more active [than in many other places]. I think that's what keeps you healthy, keeping moving. Because back home, the seniors' idea of exercise is walking from the car to the restaurant," she says.

"If you sit too long, you stiffen up and you can't move. You've got to keep moving. It's good for your health, your body."

Into Thin Air

The phenomenon is known as the "mountain filter" -- the mountains attract people who are already healthy and active and filter out those who aren't.

Marshall Denkinger, MD, is chief medical officer for St. Anthony Summit Medical Center, the county's hospital. He subscribes to the "mountain filter" theory, in both health and wealth.

"Summit County is not an easy place to live. The average elevation is 9,000 feet or above. That poses some unique challenges on the human body," he says.

He sees evidence of the locals’ hardiness all the time, in things like higher bone and muscle density for older patients, and just an overall lack of obesity and low prevalence of tobacco smokers.

There are also the seasonal weather extremes and high cost of living compared to the rest of the country. That requires a baseline that only the most fit and dedicated residents can meet. You've got to be willing to shovel your driveway 8 months of the year."

Those risks of high-altitude living include high blood pressure, nocturnal oxygen desaturation (a lack of oxygen while sleeping), and trouble breathing in the thin air in general, he says. These, along with the snow and cold weather, lead to older people moving elsewhere when their health declines. That means they die in other counties, another thing that could be skewing Summit County statistics.

Clearly, the risks aren't keeping seniors away from the mountains. According to the U.S. Census, the number of residents 62 and over in the county increased from 3,125 in 2010 to 4,136 in 2017, helping to raise the median age of the county from 36.4 to 38.2. (6)

The population movement from low to high elevation is so unique worldwide -- in most regions, high-altitude dwellers have lived there for generations, if not centuries, Denkinger says -- his hospital recently launched the High Altitude Research Center to look into the long-term physical effects of mountain living.

"Essentially the longevity in Summit County only dates back a generation or two at most, and the predominant group in Summit County has moved here from lower altitude. In countries like Tibet, Nepal, you're looking at a few thousand years," he says.

"In terms of populations above 9,000 feet in the world, this is the newest and largest."

Younger People

Bike to Work Day is a national movement, when tens of thousands of people each spring and summer forgo cars in the name of health and fitness.

Adrienne Saia Isaac's bike to work is a bit rougher than most -- 11 miles and 1,500 feet of climbing, up to the 10,780 feet at the Arapahoe Basin ski area, where she is marketing & communications manager. It's just one way people around here work fitness into their daily routines.

"The stuff we do in Summit County looks crazy to a lot of people, but to us, where there are mountains, it's just how you get around," says Isaac, 35.

It's an area where people think nothing of getting up at 3 a.m. to ski uphill in the wilderness for 7 hours to then ski down one run of untouched powder, or pedaling a bike up to 11,990-foot Loveland Pass, the highest year-round highway pass in Colorado.

But Summit County is also a resort area with a reputation as a party spot, leading the state in the number of people who reported binge drinking within the past 30 days.

Most locals attribute such statistics to tourists and seasonal employees who come here to party. For her part, Isaac says she used to drink too much and smoke cigarettes before moving to Summit County from Pennsylvania.

"When I moved to Colorado, I was 25 and I was partying way too much, and I realized that my body wasn't able to keep up with that lifestyle. So I chose to make changes," she says. "The altitude really changed how I felt about fitness, because it was more difficult to do a lot of things."

She gave up cigarettes and watches her drinking -- because coughing fits and hangovers don't go with the active mountain lifestyle.

"When you're around so many active people, it inspires you, especially when you see people older than you beasting it up a trail in front of you or just ripping on skis downhill; it makes you want to be that person."

Denkinger, the hospital chief medical officer, agrees with the assessment that the binge drinkers and smokers are most often found among the tourists and temporary residents.

"I would argue with you that most of the active, nonsmoking long-term residents of the county are not binge drinkers," he says. "You find a high prevalence of binge drinking (during) spring break in resort communities. That's naturally going to gravitate toward the visiting vacationers and the younger seasonal employees."

Wealth Inequality

Every morning, the mountain passes into Summit County are full of commuters. The chairlift attendants, hotel room cleaners, and restaurant waiters are often are forced to live in other counties and drive an hour or more each way for work.

That's because Summit County is one of the most expensive places to live in Colorado. According to a 2017 study, a family of three would need to make $63,847 to afford to live there, compared with the statewide average of $51,930. That's second only to posh Aspen in Colorado. And median home cost in Summit County is $483,460, more than twice the national average.

"We have higher average annual income per family compared to the national average, but it's important to know that 90% of our jobs pay less than $50,000," says Summit County Public Health Director Amy Wineland. "People often have two or three jobs to make ends meet, so it may look like a paradise to those who come visit, but those who live and work in the community struggle quite a bit."

Research has shown that wealth can be a key to longevity. One recent study noted that over the last 15 years, life expectancy increased by 2.34 years for men and 2.91 years for women who are among the top 5% of income earners, but by just 0.32 and 0.04 years for men and women among the bottom 5%.  

Wineland believes economics are a reason the county also has a suicide rate that is three times the national average.

"Because we have so many transplants that come from all over the nation to live and work in our community, they're finding there are lots of social, financial, and cultural disparities between the wealthy and the working class," she says.

Tamara Drangstveit, executive director of the Family and Intercultural Resource Center in Summit County, says many of her clients spend 50% to 60% of their income on housing and 15% on child care. And, she notes, Summit County has some of the highest medical costs in the nation.

One report showed the average hospital inpatient cost was $786 per insured person, 61% above the state average, even though admissions were 10% below the state average.

"The challenge is then you're faced with health insurance, housing, and child care costs, which are all far more expensive than other parts of Colorado and other parts of the country," she says.

"There's definitely a divide between people of means and people without means."

At the St. Anthony Summit Medical Center, Denkinger said medical costs are higher because everything is more expensive in a mountain community. He also noted that, other than the ski resorts, most employers are small, locally owned businesses that have been challenged to provide affordable health insurance because of their small size.

He noted that Summit County has a "nationally recognized level-three trauma center and Flight for Life operations," facilities that are larger than in most counties with a population of 30,000 people. And while the hospital has worked to expand the number of medical specialists, some services, such as rheumatology, still require a trip to Denver.

But those who struggle financially are not impacting the county’s overall health, and experts point to several reasons: Many live outside the county and commute to work here, and those who do live in the county make up a small statistical grouping, compared with the more financially stable people who are more apt to be healthy. For example, though suicides were high in 2016, with 13 deaths, it’s an overall small number, compared with the entire county’s population.

Social Connection

On a recent morning, Donald and Kathy Rowe were exploring a mining ghost town high in the Rockies, reached via a strenuous but rewarding hike.

A retired sales and marketing manager for a high-tech company, Donald says he wasn't surprised to learn about Summit County's longevity.

"People are doings stuff all the time. They're always outside. They're hiking. They're biking. They're skiing. They're fishing. People just tend to do things outside," says Rowe, 77, a part-time resident of Summit County.

The Rowes were hiking with friends from Seattle who used to live in Summit County. Mitch and Vicki Kaman have noticed the extra effort it takes to get some exercise.

Says Vicki: "My doctor didn't believe I was as active as I am. I said, 'Well I'm from Summit County. It's what you do. You don't dare admit you're inactive around here.' "

Those are two other things making Summit County so healthy: Trails, mountains, ski areas, and other opportunities for fitness are nearby, and so is a network of like-minded peers to motivate people to use them.

Back at the Summit County Senior Center, retiree Linda Bannister puts it this way: "Put up, shut up, and keep moving."

"We just have to keep moving. We're scared to stop. Rigor mortis might kick in."

Meanwhile, for Ken Willoughby and Doris Spencer, the summer is being spent climbing mountains. Colorado has 54 mountains above 14,000 feet, and though they've climbed them all before -- not to mention hundreds of other peaks and the high points of 49 of 50 states -- Willoughby wants to climb all the Colorado "fourteeners" again, in his 80s.

The two met 22 years ago at a function for the Over the Hill Gang, a ski club for seniors, and they serve as each other's motivation. And they don't foresee a time when they won't be climbing.

Says Willoughby, "I don't see the end coming, even though I'm 80, as long as I can stay active and healthy, and that's what I'm trying to do."

"We've started it, and it feels good. We're not as fast as we used to be by any means, but we do get to the summit. It's good aerobically, that's for darn sure, and we just love it," says Spencer.

"A lot of older people, when they start to slow down -- like Ken and I have slowed down -- they give it up, I think it's too hard on their ego," she says. "And we don't care if it takes us longer. We still get there."

"To climb to the summit of a mountain has never gotten old."

And at this rate, neither will they.

WebMD Article Reviewed by Brunilda Nazario, MD on November 01, 2018

Sources

JAMA Internal Medicine: “Inequalities in Life Expectancy Among US Counties, 1980 to 2014; Temporal Trends and Key Drivers.”

www.summit.co.us: "Summit County Population History, 1970-2010."

www.census.gov.

www.bestplaces.net.

www.khn.org: "The 10 Most Expensive Insurance Markets In The U.S."

Colorado Legislative Council: 2017 Colorado School District Cost of Living Analysis, March 2018.

News release, Massachusetts Institute of Technology.

summitdaily.com: "Summit County couple stays young with 120 days of ski mountaineering."

Ken Willoughby, Summit County, CO.

Doris Spencer, Summit County, CO.

Linda Bannister, Summit County, CO.

Carol Faust, Summit County, CO.

Marshall Denkinger, MD, chief medical officer, St. Anthony Summit Medical Center.

Tamara Drangstveit, executive director, Family and Intercultural Resource Center, Summit County, CO.

Adrienne Saia Isaac, Summit County, CO.

Amy Wineland, Summit County public health director.

 

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