The Okinawa Centenarian Study: Longevity and the Challenges of a Westernizing Society

Healthy centenarians are compelling exemplars of successful aging. For nearly five decades, the Okinawa Centenarian Study has documented biological, psychosocial, and cultural correlates of exceptional longevity in Okinawa, Japan-long recognized as a "Blue Zone." This commentary synthesizes historical context, the role of residential public health nurses, and findings from our "Ikigai" (life meaning) survey of 224 robust centenarians, alongside illustrative case vignettes. While Okinawa once led Japan and the world in life expectancy and low cardiovascular mortality, rapid westernization has coincided with a shift from robust, home-dwelling centenarians toward a higher proportion of dementia and bed-ridden status. We discuss "resilient longevity," compression of morbidity, and ikigai as advance (protective) factors, and highlight policy challenges in maintaining social cohesion, purpose, and healthy behaviors amid lifestyle transitions.