[HTML][HTML] Geroscience and the challenges of aging societies

F Sierra - Aging Medicine, 2019 - ncbi.nlm.nih.gov
F Sierra
Aging Medicine, 2019ncbi.nlm.nih.gov
The world is aging. With both an increase in longevity and a decrease in fecundity, currently
there are more individuals over 65 years of age than children aged< 5 years. This is fully
uncharted territory for humanity. The process is worldwide. While the process has been slow
in more developed societies, it has been extremely rapid in de‐veloping ones, causing
severe turmoil. In addition to the personal cost in terms of a large and growing number of
individuals suffer‐ing from diseases, loneliness, neglect, and lack of personal support, aging …
The world is aging. With both an increase in longevity and a decrease in fecundity, currently there are more individuals over 65 years of age than children aged< 5 years. This is fully uncharted territory for humanity. The process is worldwide. While the process has been slow in more developed societies, it has been extremely rapid in de‐veloping ones, causing severe turmoil. In addition to the personal cost in terms of a large and growing number of individuals suffer‐ing from diseases, loneliness, neglect, and lack of personal support, aging of the population implies increased costs in health care, as well as a dramatic need for increased resources needed to sustain a growing nonproductive fraction of society. As a result, the tradi‐tional view is that this demographic change represents an enormous social, personal, and economic challenge to modern society. But is this so? Every cloud has a silver lining, and perhaps the aging of the population represents an opportunity instead. After all, population aging is the result of outstanding advances in medicine and public health that have led to improvement of sanitation and conquering of many diseases and conditions. Success in the early 20th century was primarily in the containment of early childhood mortality, childbirth mortality for women, and virtual eradication of many transmissible diseases, thanks to actions on public health and hygiene as well as the development of vaccines. More recently, trends in extended longevity have also been observed for the> 50‐year‐old population, implicating successes in the fight against major killers, such as cardiovascular disease, cancer, and others. As a re‐sult, mortality rates have decreased for all age groups, including the oldest‐old. This reflects reduced morbidity at all ages and it means that a 75‐year‐old “elderly” person now has a physiological age and vitality comparable to that of a 65‐year‐old of just one to two de‐cades ago. It should be possible to continue progressing with this enormous success, and viewed in this context, the so‐called aging tsunami represents instead an opportunity: the longer individuals keep their health, the higher their productive potential during their lifetime. Indeed, studies have shown that retarding frailty by just a couple of years yields an economic dividend of billions of dollars on health‐care savings, even without considering the potential for continued productivity. 1 Therefore, if properly handled, aging of the society actually represents an economic and social opportunity, not a burden or a source of concern. 2 However, to take full advan‐tage of this opportunity, it will be necessary to modify our approach to combating the chronic diseases that are the major blockage to achieving productive and healthy lives as we grow older. The current predominant approach in biomedicine, at least in Western societies, is to attack diseases one at a time and with a strong emphasis on those diseases with the highest mortality, at the expense of other conditions, such as chronic pain, frailty, and fatigability, which—with‐out being deadly—truly rob older adults of their quality of life. This model has some advantages, as people afflicted by those diseases are seeing an extension of their life spans and their diseases being, if not cured, at least managed. However, at the population level, it is estimated that completely curing cancer and cardiovascular disease will only add a few years to the overall life span. 3 This is because, unfortunately, older persons rarely suffer from just one disease, a situation termed “multimorbidity” or “comorbidity.” This means that postponing and/or treating one deadly disease often means that the individual will be affected soon …
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