The study of centenarians is one of the fastest evolving fields of gerontology. In a seemingly paradoxical counterpoint to their almost inevitable tally of frailties, this group is simultaneously endowed with a remarkable psychological and physical toughness: the meek and the weak have died at earlier ages, rather like the first waves of Mosquitos succumbing to the flak as they fly up the fjord in 633 Squadron. Understanding the secrets of these super survivors may hold the key to healthy longevity for the rest of us.

Given the general negativity about ageing, it will be a surprise to many that a sense of humour is seen as hugely important by hundred-year olds in many studies (1). As noted by George Burns, the centenarian American comedian, if you live to be one hundred, you’ve got it made: very few people die past that age. This was matched by the oldest woman in the world, Jeanne Calment, who so impressed a journalist that on leaving he said: “Until next year, perhaps?” Her reply was “I don’t see why not:  you don’t look so bad to me.”

Putting across this positive energy to the profession and the public is a challenge. Help comes from an unexpected source: a delightful Swedish comic novel, oxymoronic as that combination of words might sound. The Hundred-Year-Old Man Who Climbed Out of the Window and Disappeared has already sold over a million copies in Sweden and is light years removed from the woes of Strindberg, the angst of Bergman, or the grand guignol grunge of The Girl with the Dragon Tatoo.

In keeping with the self-deprecating humour of the book, the story line starts just as the title suggests, with Allan Karlsson escaping from his nursing-home to avoid his 100th birthday party. In a very contemporary insight into how nursing homes, even in Scandinavia, still fail to be truly “home,” Allan is fleeing from the rule-bound director who keeps confiscating his stash of vodka, rightly fearing that the party will be more of the same.

Hindered by his creaking knees and what the residents call “pee-slippers” (a novel hermeneutic on prostatic ageing), he makes it to the bus station. On a whim, he makes off with a large suitcase belonging to the disorganised minion of a drug baron. What follows is a delirious and gerontologically-attuned mix of Midnight Run, Forrest Gump, and the The Adventures of Baron Munchausen. It would be unkind to spill too many details for those have not yet read this book: suffice it to say that it should carry a health warning for spouses or partners who are easily irritated by the sounds of helpless chortling.

With a light touch, the author also brings us through other areas of interest to medical readers. An example is the programme to sterilize the “deviant” and those with mental illness, whereby over 60,000 people were sterilized in Sweden between 1934 and 1975. Approached from the point of view of a child and refracted through the author’s deadpan humour, the horror of the unthinking societal consensus for this barbaric practice strikes home in a way that a polemic would not.

We are also gently guided through a life-course review, a seminal gerontological theory whereby later life is recognised as a time whereby our synthesis of our memories and experiences matures so that our understanding of our existence—and possibilities for happiness and inner peace—continually improve. With our hero we come to identify with Jung’s dictum that the afternoon of life must have a significance of its own, and cannot be merely an appendage of life’s morning.

However, the supreme achievement of this book is that we embrace the centenarian hero without condescension, pity, or qualification. Even though the limits of his physical reserve intrude regularly, whether through his failing joints, weak bladder, or his propensity to frequent naps, this in no way diminishes his vitality, characterisation, and interest to us.

The reason this matters is that at the core of the ugly phenomenon of ageism, a key factor in the poor treatment of older people, is a failure to truly identify with older people as peers and equals. In the creation of Allan Karlsson, the author Jonas Jonasson has eroded this gap with wit and wisdom worthy of a centenarian.

The Hundred-Year-Old Man Who Climbed Out of the Window and Disappeared
Jonas Jonasson, Hesperus Press, released 12 July 2012

Reference
1.    Koch T, Power C, Kralik D. Researching with centenarians. International Journal of Older People Nursing 2007;2:52–61.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine in Dublin, and chair of the National Centre for Arts and Health, Dublin doneill@tcd.ie