Ageing

Risk Factor for Diseases and Potential for Prevention

The population in the WHO European Region is ageing rapidly: its median age is already the highest in the world, and the proportion of people aged 65 and older is forecast to increase from 14% in 2010 to 25% in 2050. People in nearly every part of the Region are living longer, but their chances of spending these later years in good health and well-being vary within and between countries.

THE UNDERLYING MECHANISMS OF AGEING

The diseases and disabilities of aging are caused by the accumulation of damage in our tissues over time. During our first two to three decades of life, developmental programs build out our growing bodies, laying down the cellular and molecular structures of our tissues in exquisite fidelity to the instructions carried in our genetic code. From form flows function: the pristine condition of the microscopic machinery of life ensures its silent, unimpeded functioning, manifested in the health and vigor of youth.

Most of us first begin to notice age-related decline in tissue function when we’re in our forties or fifties. The cushioning of our joints becomes thinner and weaker; our kidneys become progressively less effective at filtering our blood; our immune systems weaken, leaving us vulnerable to infections that we would once have dismissed with a few sniffs. Ultimately, minor aches and mysterious malaise devolve into clinical diagnoses. Atherosclerosis. Cataracts. Alzheimer’s and other dementias. Parkinson’s disease. Cancer. Why?

The fundamental drivers of degenerative aging lie in the biochemical and cellular side-effects of essential metabolic processes in the body. The business of life is carried out by intricate, interlocking, tightly-regulated cycles of biochemical reactions in our bodies – but these reactions have to be executed in the hurly-burly of living cells and tissues, rather than in the neat isolation of a laboratory Petri dish. Minor biochemical accidents are frequent and inevitable incidents in these cellular laboratories, and many of them cause microscopic damage to the structure of our tissues. In addition, our cells are sometimes forced to make “decisions” in response to immediate crises that ensure short-term function and survival, but that also contribute to the overall burden of damage in our tissues.

These myriad metabolic mistakes leave their mark in our tissues every day, but at such low levels that they are not individually noticed, and instead take many decades to build up to the levels where the tissues begin to cease proper functioning. Thinning skin, clouding eyes, muscles sapped of strength, heart disease, cognitive decline… all of the diseases and disabilities of aging flow from the inexorable degradation of the integrity of the cellular and molecular machinery that carries out the essential functions of our tissues.  And as this process continues, the body’s increasingly-desperate attempts to repair or compensate for the rising tide of damage become chronic and maladaptive, leading to self-perpetuating inflammation, oxidative stress, and other secondary metabolic aberrations that further impair our health.

PROMOTING GOOD HEALTH AT ALL AGES

The European Commission and the World Health Organisation has identified active and healthy ageing as a major societal challenge common to all European countries, and an area which presents considerable potential for Europe to lead the world in providing innovative responses to this challenge. The European Society of Preventive Medicine seeks to support citizens to lead healthy, active and independent lives while ageing; improving the sustainability and efficiency of social and health care systems;boosting and improving the competitiveness of the markets for innovative products and services, responding to the ageing challenge at both EU and global level, thus creating new opportunities for businesses.

The need for healthy ageing is a challenge to all European countries. By 2025 about one-third of Europe’s population will be aged 60 years and over, and there will be a particularly rapid increase in the number of people aged 80 years and older. This will have an enormous impact on European societies. There are powerful arguments for investing in health as an objective in its own right. Health is also an important determinant of economic growth and competitiveness. Investing in healthy ageing contributes to the labour supply, decreasing the likelihood of early retirement.

FROM REACTIVE MEDICINE TO A PROACTIVE SYSTEM

Sustaining health and body functions across the lifespan should be a main concern from early on.

AGEING ACROSS THE LIFE COURSE

Populations around the world are rapidly ageing. This is a cause for celebration. In part it reflects our successes in dealing with childhood disease, maternal mortality and in helping women achieve control over their own fertility.

Ageing presents both challenges and opportunities. It will strain pension and social security systems, increase demand for acute and primary health care, require a larger and better trained health workforce , increase the need for long term care and for environments to be made more age-friendly.

However, the opportunities are just as large. Older people are a wonderful resource for their families, communities and in the formal or informal workforce. They are a repository of knowledge. They can help us avoid making the same mistakes again.

Indeed, if we can ensure older people live healthier as well as longer lives, if we can make sure that we are stretching life in the middle and not just at the end, these extra years can be as productive as any others. The societies that adapt to this changing demographic and invest in Healthy Ageing can reap a sizeable “longevity dividend”, and will have a competitive advantage over those that don’t.

This will require a transformation of health systems away from disease based curative models and towards the provision of older-person-centred and integrated care. It will require the development, sometimes from nothing, of comprehensive systems of long-term care. It will require a coordinated response from many other sectors and multiple levels of government. And it will need to draw on better ways of measuring and monitoring the health and functioning of older populations.

HEALTHY AGEING IS A PRIORITY

The European Commission has identified active and healthy ageing as a major societal challenge common to all European countries, and an area which presents considerable potential for Europe to lead the world in providing innovative responses to this challenge. The European Society of Preventive Medicine seeks to support citizens to lead healthy, active and independent lives while ageing; improving the sustainability and efficiency of social and health care systems;boosting and improving the competitiveness of the markets for innovative products and services, responding to the ageing challenge at both EU and global level, thus creating new opportunities for businesses.

The need for healthy ageing is a challenge to all European countries. By 2025 about one-third of Europe’s population will be aged 60 years and over, and there will be a particularly rapid increase in the number of people aged 80 years and older. This will have an enormous impact on European societies. There are powerful arguments for investing in health as an objective in its own right. Health is also an important determinant of economic growth and competitiveness. Investing in healthy ageing contributes to the labour supply, decreasing the likelihood of early retirement.

LIFESTYLE AND AGEING

Considerable gains in terms of mortality and function could be achieved if older people adopted a healthier lifestyle with healthy eating habits. Obesity and overweight are associated with unhealthy dietary habits and lack of physical activity. The broad benefits of physical activity for older people are well documented and associated with improved length and quality of life. People tend to become progressively less active as they get older.

REFERENCES AND CONTINUED READING