Ask anyone and they will tell you that they don’t think they are as old as they are. And yet, you might also hear the same person complain about “feeling old” when asked to complete some physical task like walking up stairs. This sums up a major problem with research into ageing – what is old and how old are you really?
We have been taking part in a longevity revolution. But we are not only living longer, our concept of when we transition from middle age has also changed. In the 1920s we were thought to be old from age 44 whereas it is now thought to be around 60 for men and 65 for women [1]. Many observers say that we are standing on the precipice of yet another revolution in lifespan modification. In this brief series we mark the completion of the clinical phase of the MID-Frail study [2], a major new international research study examining the effectiveness of combining optimised medical management with exercise and dietary programmes to maintain function and quality of life in people aged over 70 years who have Type 2 diabetes, and the first phase of the Frailomic initiative [3], a large scale research project aiming to identify the factors that turn frailty into disability, by taking a snapshot of current developments in the science of ageing. These large research projects being run by Niche Science & Technology Ltd. are funded by multimillion Euro grants from the European FP7 Framework and reflect the concern governments have over the impact that population ageing will have in the next decade.
Everyone agrees that better sanitation, trash collection, electricity, freezers, immunisations, and better and better healthcare are all factors that have led to longer life expectancy. But it also means that more and more people are becoming what we call "elderly." This might not bother some people because the news is full of stories about 70-year-olds running races and finishing triathlons. However, these individuals are rare, while most people will weaken over time. When you are frail, you get tired, weak, lose weight, lose muscle mass, and lose power. Also, as we get older, the chance of getting diseases like diabetes, dementia, and heart disease all at the same time goes up a lot.
The outlook is not good as you get older. When added to longer life expectancy, this means that many people will have to deal with frustrating loss of usefulness for long periods of time. This is the most problematic effect of the population getting older. Furthermore, the costs of care are very high. Because of worries about how much it will cost to get older, governments are making it harder to join retirement plans. When they were first introduced at the end of the 1800s, pensions were meant to help the elderly. However, they have not kept up with the changing demographics of our ageing population, and plans are now financially unsustainable. Who will pay for 30-year retirements if frail 70-year-olds can't keep working, and how will society pay for the care of more and more weak people? As people try to live forever, society has a hard time getting used to the fact that more and more people are living longer.
For you, as an individual, it seems that the most poignant question is not ‘How old are you?’ but more likely ‘Are you going to become frail?’ Landmark studies have developed valid models for frailty and these have allowed epidemiological studies to demonstrate the association of frailty with quality of life and adverse health outcomes. New research is needed to discover more efficient methods to detect and severity grade frailty as part of routine clinical practice, particularly methods that can be used in the primary care setting. This would greatly inform the appropriate selection of older people for invasive procedures or medications and could be the basis for a paradigm shift in the care of frail older people towards a more appropriate goal-directed care. Our Frailomic initiative is looking at the possibility of predicting frailty through identification of predictive biomarkers. Currently, you can only assume your health status in your retirement years based on population data. For example, the Cardiovascular Health Study [4], a US study of more than 5,000 participants 65 and older, found that 9.5% of those 75–79 years of age were frail. Among those aged 80–84 years, about 16% were frail, and nearly a quarter of those 85–89 had overt frailty. Clearly, as the study was conducted in the USA these figures reflect data from a wealthy Western society whereas countries with fewer resources are likely to fare less well (though we shouldn't discard the observation that many of the unpleasant consequences of ageing reflect the excessive practices associated with the Western lifestyle). Will we ever be able get an idea how best we can prepare for a healthy old age? When will it start? How long will it last? What treatments will provide improvements in longevity and who will be able to afford them?
In my opinion, you can consider yourself old when you're around 60 years old, but you won't know if you have another 10 to 15 years of useful contribution to society or if you are a burden on it. The good news is that our media have been focused on young people up until now. It begs the question how much this might change as the working population ages and all the programs on all the channels are made by elderly actors, speaking lines by aged writers and filmed by myopic cameramen. Joking apart, the socioeconomic consequences are unfathomable.
References
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