Most people have probably heard many times the idea that one can "grow old gracefully" and in a healthy way. This message is perpetuated by the fitness and health industry and pension companies love to show the image of happy, relatively healthy 65-year-olds who can finally escape dreaded work and do what they enjoy in life, for at least a few years before a period of serious disability and death.
I'm 25 years old and while society still defines it as "young", it feels a short time since I was a teenager, and a short time until I'm pulled into a new societal, age-related stereotype. A young person is often considered a "fresh seed full of potential ", while already at 40 one might be "too old" for many jobs, in the constant repetitive cycle that is "generational change".
It is true that some people live over a century and delay many specific pathologies. I also agree that it is a more desirable scenario to die frail at 100 than earlier, but the fact is that what we define as biological aging is in itself a pathological problem, a problem that still suffers from a lack of research. While not every age-related change is studied, the damages can be broadly classified into categories, and specific biomolecular problems can be directly targeted.
While there is a small decrease in function between 20 and 40, the human body still remains "very healthy" until mid 40s when disease correlated to the aging process overtakes accidents/suicides as most common cause of death. Keeping the human body biologically under 50 years old would take away the vast majority of all disease, and even if biologically young people were obese and smoked, there would likely only be a small number of cases where these "unhealthy" habits caused lethal health problems.
The problem with WHO and governmental programs is that these systemic pathologies destroying the body and generating ill health in the elderly are not yet considered to be a disease. I have worked trying to change this paradigm. Earlier this year I coauthored "It is time to classify biological aging as a disease", and Alex Zhavoronkov and his company In Silico medicine have recently published a paper on this issue, to persuade the World Health Organisation to classify aging as a disease as a part of the International Statistical Classification of Diseases and Related Health Problems (ICD-11).
When I was a child I was told wrinkles signified wisdom and life experience, but didn’t impact one’s health in any way. Nowadays my brain is wired to spot the pathologies behind them; skins laxity and jowls linked to blood sugar crosslinking and destruction of collagen, dysfunction of matrix metalloproteinases and subsequent ECM degradation. Wrinkled skin is not simply a cosmetic issue, as senile skin is failing to perform its duties properly, similar to burned and scarred skin. Many old people become easily dehydrated, are less able to cope with temperature fluctuations, and they injure and bruise themselves easily due to the loss of components making up the main skin layer, the dermis. Skin aging in itself is yet not classified as a disease, but lesions have pathological names, and photo-aging caused by sun exposure, which shares molecular pathologies with intrinsic skin aging, is considered a pathological condition. What is humanity gaining by this hypocrisy?
Here's the problem in a nutshell
- There is a rate of systemic decline that follows a similar pattern in humans, killing people off with a most common age of death in late 80s, often preceded by dementia, sarcopenia, different forms of heart problems, followed by multiple comorbidities.
- The decline occurs due to dysfunction of the genome to maintain the body, and it is not suddenly going to go away by itself, no matter how many robots and apps we create.
- We have historically not had any way of measuring aging, neither figured out a way to classify the forms of aging damage.
What people might forget is that those born 100 years ago grew up in a world where reaching adulthood was far from guaranteed, and many suffered from malnutrition and died of bacterial infections. Few but the odd scientist cared about aging. Nevertheless in the past 10 years the swedish female life expectancy has only increased by 1.37 years, the oldest currently living swedish person is 109 years old (was 112 back in 1993), and we can extrapolate that it is going to continue similarly in the absence of medical intervention in the aging process.
Changing demographics require a new approach
We live in a society rapidly becoming less and less adapted to short lifespans and death by aging. We are enjoying a relative respite now, because fewer people reached 80+ from the 1920s cohort compared to what's expected from the 1940s cohort, but there is still a dark cloud of a financial risk hanging over society. Administrating this large group’s upcoming disability and dependence is going to be an enormous challenge.
Only a few decades ago, it was normal to only have one career which was determined early in life. There's now an increase of people in their 40s going back to university, while retirement still starts at 65 and most cannot expect to live in good health beyond 75. It is also more difficult to get pregnant at 35 than 25, despite the fact it is often a necessity to delay having children in order to climb the career ladder. All these changes fit very ill with our biology.
The past couple decades have seen an unprecedented growth in technologies, and I see the upcoming possibilities, speculations, and what might actually occur. I personally always think along the lines of "Occam's razor", before trying to pretend I have a clue. So I can infer from the laws of physics that circumstances are replicable; if the laws of physics allow "me" to be "here" in a healthy 25-year-old body right "now", those conditions should also be possible to induce at the point in spacetime we define as 100 years from now.
Classifying aging as a disease is therefore essential as soon as possible, so we can build a framework to target and cure the ill health of the elderly. The faster we do it, the faster new technologies arrive and the more lives will be saved.
Contributor Victor Björk