The Aviv Clinics at The Villages Is Where Aging Goes to Die
It’s 5:30 p.m. on a Tuesday, and happy hour has begun at Brownwood Paddock Square inside the Villages, a 55-plus active--retirement community in Florida. Gray-haired couples amble along the sidewalks of the early-1800s-western-themed town center, toting folding chairs and cooler s. A band is playing “Blue Suede Shoes” in the corral. Maskless throngs in windbreakers and visors shuffle out of the restaurants and bars, scoping out the best spots for the concert. Customized golf carts—fuchsia, blaze orange—line the curb, glimmering in the light of the setting sun.
In the past, I would have smiled condescendingly at this scene. (Aw, look at these oldsters rocking out on their new knees!) Instead, I drink it in, pondering my own mortality. I’m 55—officially old enough to live at the Villages—and am here to visit the new Aviv Clinics, which offers a compelling and potentially game-changing therapy to combat the effects of aging.
The Villages is a location, but it’s also a concept: a place where the almost old, and the actually old, go to feel less old. It’s where you can act young without being young, and it’s where an estimated 132,000 people (and counting—the metro area has one of the fastest growth rates in the country) are testing the hypothesis that feeling young is more a mindset than a number. There are 50 golf courses and more than 3,000 clubs and activities, from karate to knitting. It may seem counterintuitive, but this city/club/social experiment may offer a glimpse of the future. Your future, specifically.
Americans are an aging population for the obvious reasons. Medical breakthroughs mean more of us live longer, and the surge of baby boomers born after World War II are hitting their senior years. By 2030, one in five adults will be at least 65, according to the U. S. Census Bureau. With the power of numbers, this 65-plus crowd is changing how we think about growing old, challenging the convention that seniors should rest and take things easy.
People often compare the Villages to Disney World, given the themed town centers. But Glenn Colarossi, the head of Aviv’s business development and my host, likens it to a college campus for the retired. “They like to have fun,” he observes. The Villages is reimagining our notion of the golden years, and Aviv is greasing the wheels—and joints—of this revolution. Its goal, Colarossi tells me, is to increase a person’s “health span,” not just their life span.
Pioneered by Israeli physician Shai Efrati, M.D., the clinic studies each client down to their DNA and constructs a personalized plan for staying physically and mentally healthy. The centerpiece is hyperbaric oxygen therapy (HBOT), in which patients breathe pure oxygen at varying pressures in a hyperbaric chamber, potentially inducing cell growth and expanding blood vessels in the brain. The original research center in Israel opened 15 years ago, and the Florida site opened in March 2020. If I were entering the 12-week program, I’d meet with a physical therapist, a physiologist, a doctor, and a dietitian; engage with millions of dollars’ worth of machinery; and submit DNA, which would result in a 200-page book of codes and genetic indicators that each of the experts would parse. There would be 60 sessions in the hyperbaric chamber as well as before-and-after MRI and SPECT brain scans. The program cost: $60,000. Is this just another get-young-quick fad for the rich and yet another reminder of our health-care system’s inequalities? Or do HBOT and a customized evaluation of your physiology offer some chance to counteract declining brain and body function and help in the fight we all eventually fight—the one against aging?
The Aviv lobby where I check in is a cavernous expanse of white tile and polished wood. The overhead lights double as sculptures. It is celestially sleek. If the designers were going for a God’s-waiting-room vibe, they nailed it. I’m scheduled for a sample of the three-day assessment, condensed into two days. I don’t feel or even think of myself as old. I run regularly with my wife and take boxing classes with my oldest. The other day, when I barked at my teenage daughter to get off the phone and do the dishes, she muttered, “Grumpy old man.” We locked eyes . . . and laughed. Funny because it was so not true. But I do have persistent lower-back pain, and odds are 50-50 I get up in the middle of the night to pee. Then there’s the looming shadow of declining brain function, which for someone who lost his father to Alzheimer’s is too terrifying to joke about.
My first evaluation will determine my physical and cardiopulmonary state. I meet with Ankita Shukla, D.P.T., a trim, sharp woman who runs me through a gauntlet of tests to measure the flexion, extension, rotation, and abduction of every joint in my body, zeroing in on the limited range of motion in my neck and back . . . and (sigh) knees, wrists, and hips.
In one test, to assess my “dual-task ability,” she asks me to briskly walk to a cone while counting down from 100, subtracting each number by three. I utter only two numbers, one of which is right. On my second attempt, I actually count forward, not backward. She recommends a serious stretching regimen for my body, neck, hips, and wrists. For posture, she offers a quick cheat: stand with my back against a wall for more than a minute at intervals throughout the day. To increase my dual tasking, she suggests I count backward—numbers, months, the alphabet—during my workouts.
Shukla hands me off to physiologist Aaron Tribby, a fit young man who is a body-movement specialist. Tribby straps me into the Gaitway 3D, a biomechanics treadmill that measures my gait and step pressure to check my coordination and see if I’m losing functionality. I have some foot rotation, which might be caused by tight hip flexors, taut hamstrings, or rigid ankles. He gives me exercises to remedy all three.
Next, I visit Roger Miller, Ph.D., Aviv’s charming clinical psychologist. “I’ve got the best job here, because everything is controlled by the brain,” he proclaims with a smile. “I’m going to tell you five words,” he instructs. “I want you to repeat them to me.” I ace it. Then I take a battery of increasingly difficult cognitive tests: the written Montreal Cognitive Assessment, or MoCA (at the end of this test, he asks me to recite the five words again; I don’t ace it); the NeuroTrax, to assess functions like memory, attention, and problem-solving; the CANTAB, which looks at processing speed, flexible thinking, and spatial memory. The results: “You showed comparative strengths in your nonverbal memory, fine motor speed and coordination, and executive-function skills.” And in a sentence ripped right from my wife’s playbook: “There were relative weaknesses in your information-processing speed and sustained attention.”
None of the testing so far is super cutting-edge, and the advice, while sound, is mostly stuff I knew I should be doing. I then meet with Mohammed Elamir, M.D., the lead physician at Aviv who runs point on interpreting all the data from the team, including from specialized brain scans that track blood flow in the brain and identify diminished zones, to gain a holistic view of how a patient is aging. I didn’t get the brain scans, so Dr. Elamir gives me a basic neuroscience history lesson, which like everything else at Aviv traces back to its cofounder Dr. Efrati. Dr. Elamir tells me he was drawn to Aviv because he came across research by Dr. Efrati that indicated that central-nervous--system cells in the brain could regenerate and rejuvenate. “That is not what we were taught in medical school,” he says. “This was not deemed feasible.” Now, he says, thanks to Dr. Efrati’s HBOT research, there is preliminary evidence they can.
Dr. Efrati is a professor at the Sackler School of Medicine at Tel Aviv University and the founder and director of the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center. He has been studying the effects of hyperbaric oxygen therapy for more than 20 years, he tells me on a Zoom call. He’s 50, with close-cropped gray hair and a warm, TED-talk-polished bedside manner. Dr. Efrati says he developed an interest when a stroke patient with an ulcerated leg wound was put in a hyperbaric chamber—an accepted wound therapy. After a series of treatments, he noticed the woman’s neurological disabilities were improving as well. This led him to investigate the regenerative effects of HBOT on the brain. He discovered in 2007 that, indeed, “neurons and blood vessels in the brain can be regenerated.”
The apotheosis of his work was identifying a phenomenon called the hyperoxic--hypoxic paradox. By manipulating levels of oxygen in the chamber, you can essentially fool the body into perceiving that it’s being starved of oxygen, a state called hypoxia, without harmful side effects. During the hyperoxic stage, oxygen floods the cells. According to Dr. Efrati, this can promote the production of stem cells, valuable because they can develop into most any cell in the body. The treatment can also promote the branching of new blood vessels into areas of the brain damaged by events like strokes.
Dr. Efrati started treating stroke patients with HBOT in 2007, then brain--trauma patients in 2008. Today, he works with people who want to remain physically and mentally active. “About five years ago, we decide we move forward with targeting aging as a disease,” he says.
Dr. Efrati’s recent research results are intriguing. Notably, a November 2020 clinical trial of 35 people ages 64 and older indicates that HBOT can increase the length of telomeres, the area of specialized protein at the ends of chromosomes. (Telomere shortening is a sign of aging.) Another of his clinical trials published last June, of 63 patients, found evidence of cognitive enhancement in adults ages 64 and older after HBOT. The specific benefits were increased cerebral blood flow resulting in improvement in executive function, information--processing speed, and attention.
However, there is skepticism in the wider medical community. Usually, small clinical studies would be followed by larger, multicenter, randomized clinical trials, says James E. Galvin, M.D., M.P.H., a professor of neurology and the director of the Comprehensive Center for Brain Health at the University of Miami. This has not happened with HBOT yet. Dr. Galvin, who is engaged in dementia--prevention-and-therapy research, is familiar with Dr. Efrati’s work. “I think one should be cautious about overinterpreting results from very small studies performed at single sites with very small effects,” he says. “I’m not discounting the research. There’s just not a lot of research on HBOT use in patients with various forms of dementia.” He adds that the majority of studies appear to be on only one type of dementia: vascular. “I’m cautious about rushing treatments for broad commercial use before the research shows it’s effective.”
Even though HBOT therapy is new, I see about 20 other patients during my visit, mostly couples, in their 70s and 80s. (Aviv declined to reveal patient data.) I’m reminded of something Dr. Elamir told me: The motivation for treatment he hears most from patients is not wanting to be a burden on their partner when cognitive decline, dementia, or stroke makes them less independent. One patient I talk to, Elliot Sussman, M.D., is the chairman of the Villages Health health-care provider. Dr. Sussman, 69, is 45 “dives”—what they call sessions in the hyperbaric chamber—into the program. Even though the preprogram MRI of his brain was normal, his goal, he says, is to sharpen his cognitive function. But the most notable effect for him has been “a significant increased need for sleep,” he says, an additional hour or more every night. This is good news, the doctors told him, a sign his brain is regenerating and repairing, in the same way babies need sleep to aid development of their growing brains. It may seem underwhelming, but Dr. Sussman feels the investment will pay off.
After a night observing the Villages’ frenetic social scene, I’m up early the next morning to meet registered dietitian Kathryn Parker, a cheery woman with flowing gray hair. She has me stand on the Seca Medical Body Composition Analyzer and grip the handles. Within minutes, a report is compiled that assesses my water composition (good, at 58 percent), my visceral adipose tissue (fat around my organs, which is very good, at 1.9 on a chart that goes to 5), and a host of other things, including skeletal muscle mass (which at 63 pounds for my 167-pound body is okay; she wants it to be between 64 and 84). I’m losing muscle mass as I age, and I’ll need it to keep from falling down when I’m actually old. She suggests I do more strength training and eat more protein daily. (MH advises eating about one gram of protein per pound of your target weight each day.) Parker likes nutrients to come from food (rather than supplements) and recommends snacks of yogurt, cheese, and whey-powder shakes. It’s refreshingly straightforward nutrition advice.
Then I’m back with physiologist Tribby for a spirometry and VO2-max stress test. He tapes on ten electrodes for the ECG, straps a mask over my head, and puts me on a treadmill. As both speed and incline gradually increase, I’m instructed to run until I just can’t go anymore, whatever that means. Nine minutes later, I find out. The ensuing report shows that my lung efficiency, including the amount of air I take in and forcibly exhale, is normal for my age and gender. At 34 kg/min, my max oxygen intake during intense exercise is a little better than average for my age. But before this goes to my head, Tribby points out that elite athletes test more than double that. My report is five pages of mediocrity, challenging my self-image as fit. To improve my fitness, he recommends standard stuff: exercise three or four days a week at 70 to 80 percent of my max heart rate, which is 165 bpm. I also need to work in a couple sessions of HIIT and one endurance workout.
Finally, I’m ready for my dive. The chamber is designed like an airplane’s first-class compartments to combat the claustrophobia some may feel and because it looks cool. I wear a mask to breathe the oxygen and sit in a very comfortable chair for an hour, half a regular session. The scheduled air and oxygen intervals at pressure induce the hyperoxic--hypoxic paradox. My breaths through the mask are slightly easier than breathing through a scuba regulator, but I’m conscious of every inhale and draw the air deep into my lungs. My one session won’t have a measurable effect on my brain, but I get the idea. When I emerge, I’m light--headed. That night, I sleep deeply, my brain awash, presumably, in increased O2.
My two days give me only a glimpse inside the Aviv process. The data I get from my biometric measurements puts me in a good place—no immediate evidence that my body is aging faster than my brain, or vice versa, just that I am inexorably getting older. This one-stop mind-body checkup has taught me that (a) it’s great to have access to a team of medical experts under one roof and (b) I need to adhere to health and antiaging best practices, now more than ever. Physically I’m inspired to do more stretching, improve my posture, up the exercise intensity, and eat more protein. I might even take up knitting to stay sharp. My exposure to the Villages has challenged me to look unflinchingly at the future and play and prepare for the long game.
More than anything, I’m relieved there were no cognitive red flags. I couldn’t afford the $60,000 price tag to potentially reverse a brain problem. Hopefully the science behind HBOT will be proved effective and the cost will come down. Until then, the prospect that age-related cognitive decline can be staved off gives me optimism that I’ll stay active long enough to keep that smirk off my daughter’s face for decades to come.
This story appears in the May 2021 issue of Men's Health with the headline Where Aging Goes To Die.
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