I’ve been doing this work for over twenty years. Thousands of patients. Countless conversations about skincare, diet, hormones, treatments, supplements, sleep. And if I were honest about what I’ve observed — not what the research literature says, though that matters too, but what I have observed in this room — it is this:
The patients who age most gracefully are not the ones with the most rigorous skincare routines or the cleanest diets or even the ones who train most consistently.
They are the ones who have something to get up for.
The biology of purpose
This is not a motivational statement. It is a biological one.
The relationship between psychological wellbeing, sense of purpose, and physiological ageing markers is now well-documented in the longevity literature. What has historically been described as the Japanese concept of ikigai — your reason for being, the convergence of what you love, what you’re good at, what the world needs, and what you can be sustained by — turns out to have measurable biological correlates.
People with higher sense of purpose have lower levels of interleukin-6 and C-reactive protein — two key markers of chronic systemic inflammation [1]. They have longer telomeres at equivalent chronological ages. They show better hypothalamic-pituitary-adrenal axis regulation, which means their cortisol responses are more adaptive and less dysregulated. They have lower rates of cardiovascular disease, cognitive decline, and all-cause mortality.
This is not soft science. The data is consistent across multiple large cohort studies, including the MIDUS study in the United States, the English Longitudinal Study of Ageing, and several Japanese population studies that specifically examined ikigai [2].
In my practice at SW1 Clinic, I began incorporating this dimension into my consultations about eight years ago. Not in a formal clinical protocol — I am an aesthetic physician, not a psychiatrist — but as a line of inquiry. When someone presents looking significantly older than I’d expect for their age, and the metabolic and hormonal picture doesn’t fully explain it, I ask about their life. Not their skincare. Their life.
The answers are often illuminating.
What I see in practice
There is a recognisable presentation that appears, with frustrating regularity, in women in their late 40s and 50s. The children have left or are leaving home. A career that once provided identity is changing or ending. A marriage that provided structure has shifted or dissolved. The physical changes of perimenopause are occurring simultaneously with these identity disruptions.
The skin tells the story. There is a flatness. Not just the physiological flatness of collagen loss or hormonal withdrawal — something else, harder to name but clinically visible. I’ve come to think of it as the appearance of a body that has stopped generating reasons to invest in itself.
I am not qualified to treat this clinically. But I can name it. And naming it, I’ve found, is often the beginning of something more productive than any treatment I could offer.
The Singapore context
Singapore is, in many respects, an extraordinary place to be ageing in. Excellent healthcare access, clean environment, relative safety. But it is also a culture that has oriented itself very significantly around economic productivity and family role performance — and when those structures shift, the existential dimension of ageing becomes harder to navigate.
The silence around purposelessness in middle age is culturally enforced here in a way it isn’t in Western contexts. There is less public conversation about it. There is no equivalent social permission to say “I’m fifty and I’m not sure what I’m for anymore” in the way some cultures allow.
The Japanese framework of ikigai — which has received significant Western interest in recent years — is relevant here. Not as imported wellness philosophy, but as a genuine practical framework for finding the intersection of meaning and daily life. Research from Japan, where ikigai is an embedded cultural concept rather than an import, consistently shows its association with longevity outcomes across age groups [3].
What social connection actually does physiologically
The connection piece is worth addressing separately because it is different from purpose, though related.
Social isolation is now classified as a public health risk comparable in magnitude to smoking fifteen cigarettes per day — a finding from Holt-Lunstad’s influential meta-analysis of 148 studies. The physiological mechanisms include elevated cortisol, impaired immune function, increased inflammatory marker levels, and disrupted sleep architecture — all of which accelerate biological ageing.
In Singapore’s increasingly urbanised, screen-mediated social environment, genuine connection — the kind that involves physical proximity, mutual vulnerability, shared time — is harder to maintain than the surface metrics of social activity suggest. Many of my patients are not lonely in the way they would describe loneliness. But they are isolated in the way that matters biologically: few people who know them deeply, few relationships where full self-expression is possible.
This is not a lifestyle recommendation from a wellness blog. It is a clinical observation about a biological risk factor that deserves to be in the same conversation as lipid management and SPF.
What you can actually do
Identify what gives you a sense of forward motion. Not necessarily a grand purpose — daily purposefulness, which is a more achievable and equally well-supported concept, involves having things that require you and that you care about. Patients who start a new skill — and the research on this is interesting — show measurable improvement in psychological markers within weeks. Not because the skill matters intrinsically, but because learning and mastery generate a neurological reward cycle that counters the sense of purposelessness.
Invest in relationships deliberately. Not social media connection. Physical, present connection with people you care about. In Singapore’s compressed urban life, this requires scheduling rather than hoping it happens organically.
And consider, seriously, whether your life has something in it that is bigger than you. Work. Community. Creative practice. A cause. Children, if that applies, but not only children — children eventually leave, and the organism needs other reasons to invest in the future.
I find my own answer to this question partly in medicine and partly in sport and partly in things I don’t write about publicly. The composition matters less than the fact of its existence.
The body responds to having reasons to live well. This is not metaphor.
It is the most significant longevity variable I have encountered across two decades of practice — and it is the one that appears on no treatment menu.
References
[1] Boyle, P. A., et al. (2010). Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic Medicine, 71(5), 574–579. https://doi.org/10.1097/PSY.0b013e3181a5a7c0 [VERIFY — confirm before publishing]
[2] Tanno, K., et al. (2009). Associations of ikigai as a positive psychological factor with all-cause mortality and cause-specific mortality among middle-aged and elderly Japanese people. Psychosomatic Medicine, 71(4), 394–401. https://doi.org/10.1097/PSY.0b013e3181a4c4db [VERIFY — confirm before publishing]
[3] Holt-Lunstad, J., et al. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352 [VERIFY — confirm before publishing]
