The New Age(ing) Paradigm: Healthier, Wealthier and Wiser

Francine B. Jensen
PhD Student
College of Nursing
University of Utah

Aging—it is upon you and me as we accrue weeks and months, one day at a time.  The length of time we can expect to live is increasing as well.  According to the US Census Bureau, Americans are living nearly double the years we were a century ago. 

Year	Male life expectancy in years	Female life expectancy in years
1900	46.3	48.3
1950	65.6	71.1
1990	71.8	78.8
2012	76.4	81.2

                                                          Life Expectancy, Centers for Disease Control 

WHY are we living longer?

Living longer can be attributed to many social and medical advancements since the 1900’s, including embracing the germ theory, discovering antibiotics, implementing vaccinations, and improving water treatment and sanitation.  Diseases that maimed or killed our progenitors, like cholera, tuberculosis, polio, measles, and the mumps, are now treatable and avoidable.  Living longer is great news, right?

Living longer, but at what cost?

We are all aging at different speeds and with different results.  Just look around you---you have seen 90-year-olds who look like they’re 70, and 65 year olds who look like they’re 80.  These differences can be attributed to a web of factors: genetics, environmental influences, exposure to toxins, dietary nourishment, occupation, stress, and co-morbidities, to name a few.  Some of these factors we can change, others we can’t. Unfortunately for some people, living longer means being sicker with chronic and multi-morbid conditions.   

Baby Boomers:  Wealthier and Wiser 

Boomers, the largest cohort entering old age currently, are predicted to live longer than previous generations.  More Boomers live in non-traditional home environments, have spent more time in the workforce due to the economic downturn of 2007, have more savings, use more electronic technology and are savvy with cell phones, tablets and computers (Sugar, 2014).  They were of age in the Vietnam War and watched women’s and civil rights unfold.  Due to their life experiences, Boomers are redefining what aging means and are challenging us to think about aging in different ways.  

And the U.S. government and scientists are responding, working on ways we can age better and look forward to healthier futures with the years we have left.  

Paradigm Shift 1: Healthier Aging Now and in the Future

The government and providers are serious about stimulating the public health conversation.  A paradigm shift in the last twenty years has turned America from a disease-treating nation to a health-promoting, disease-avoiding nation with the advent of the government’s initiative Healthy People 2000, 2010, and 2020.  The Affordable Care Act emphasizes access to care for everyone, making sure that as we age, we receive medical support across the lifespan.  In addition, national governmental research entities, like the National Institute on Aging, are allocating research dollars towards understanding diseases of aging, like Alzheimer’s disease.

With changes to affordability and accessibility, the aging landscape is changing for the better.  A paradigm shift means thinking about aging in new ways.  Researchers are primed to try new approaches.  

What the future looks like:  Expect to see more research results guiding aging strategies.

 Paradigm Shift 2:  Precision Medicine and Aging

Think genetic and specific: precision medicine is medical strategies for the individual person.  Precision medicine avoids a one-size-fits-all approach to aging, taking in to account your genetic make-up and the specifics of your aging process.  In 2016, President Obama announced the paradigm shift toward precision medicine with the Precision Medicine Initiative, pledging research dollars to accelerate progress toward precision treatments.  We are all uniquely aging, and precision medicine will help us age better by:

·         Screening for your genetic disease risk—catch it before treatment is needed

·         Treatment plans specific to your body’s genetic code

·         Medications dosed at your therapeutic level—treat to your threshold of appropriate responses

·         Targeting tumors and killing them quickly and efficiently—treat precisely what needs targeting

An invitation has been extended to participate in precision medicine research offered through the All of Us initiative, sponsored by the National Institutes of Health.  The goal is to have one million participants’ data gathered “to accelerate research and improve health.” This will go a long way toward helping us understand issues associated with aging.

Paradigm Shift 3:  Team Science and Aging

We are better together.  In the past, researchers worked in isolation to solve problems.  However, the new approach in research is using Team Science. Team science is a paradigm shift that harnesses the collaborative powers of researchers across disciplines to tackle sticky, complex, multi-factorial problems.  The increasing internet abilities harnessing Big Data has enabled this shift to occur.  Working on ubiquitous problems common to humankind just got easier. The realities of this are that researchers can connect with like-minded researchers around the world, and the power of their studies to benefit us has increased.

The aging-well paradigm lends itself to a team-science approach, as stakeholders collectively put their minds toward helping people feel, act and live better.  Innovative research strategies, like Patient Centered Research approaches, listen to aging people’s concerns and suggestions while designing research projects.  As older adults become more involved in research, outcomes will be strengthened and benefit older adults throughout the world.

What the future looks like:  Researchers, aging adults, doctors, nurses, physical therapists, economists, psychologists, sociologists, insurance companies, healthcare systems and others, combining efforts to design research strategies to improve aging’s future landscape.  What can you do?  Get involved in aging research in your area.

Health Technologies: Various Kinds and Purposes

In the last decade, the technological explosion has populated our world with devices and apps.  Technologies provide real-time information about what we do and when we do it.  For those aging, electronics are powerful tools that can:

• ·         Remind us when and what to eat
•        Monitor our movements
•        Encourage us to exercise
•        Track our intake and output
•        Notify of a fall or life threatening cardiac rhythm

Remember the Boomers?  Many have money to spend on devices that perform these functions, thereby assisting them to age better.  Younger generations are already primed to develop and use technological advances to assist them aging better than their parents and grandparents.

Challenges to consider: How do we help aging adults tap into the power of gadgets, apps, and electronic health information to promote their health?

Another exciting development with advancing technology is the field of regenerative medicine.  Previously when bodily function was lost due to aging or disease, there was no recourse.  However recently, 3-D bio printing is allowing us to manipulate materials in order to bio-print tissues and structures for the human body (Murphy & Atala, 2014).

Image of schematic of bioprinting.  License: Centromere121 (https://commons.wikimedia.org/wiki/File:Organ_printing_Step_1-2-3.png), Organ printing Step 1-2-3, https://creativecommons.org/licenses/by-sa/3.0/legalcode

Bladders, cartilage, and skin have been successfully printed, and the capabilities are growing exponentially.  For the aging adult, bio-printing offers new vistas for degenerating body parts thereby prolonging functionality.  The future is brighter for some diseases as this capability grows.  

The type of tool that does the work to bioprint. Image of Bioprinter obtained from By Андрей Ильин [CC0 or CC0], via Wikimedia Commons; Attribution not legally required.

What Can You Do?

Aging is a complex process.  While researchers are helping delineate many aspects of aging, there are things we can do to help ourselves.  Reichstadt et al. (2010) identified ways we can psychologically age better, including staying involved in a range of activities to engage in life, purse novel activities, connect with family and friends, and generate social interactions.  Gerontologist Judith Sugar (2014) notes additional strategies to stay physically heathy while aging:

• Consistently exercise with non-weight bearing and weight bearing activities
•  Eat a variety of foods
•  See your doctor for routine care and worrisome symptoms
•  Decrease your levels of stress
•  Sleep well

Start Early, Be Involved

What does this mean to you and me?  None of us is getting any younger, yet there is so much we can do to age better than we are.           

• Actively buy in to the aging-well paradigm. 
• Take advantage of precision medical strategies that are increasing exponentially.  
• Let technology assist you with devices and prompts to eat well, move more, and stay informed.
• Get involved in the aging research.

By utilizing these strategies, we surely can age healthier, wealthier and wiser than we currently are.

References

US Census Bureau  https://www.census.gov/prod/99pubs/99statab/sec31.pdf

Centers for Disease Control  https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_08.pdf

National Institute on Aging https://www.nia.nih.gov/research/publication/global-health-and-aging/living-longer

Sugar, J. (2014).  Introduction to aging: A positive, interdisciplinary approach. New York, NY: Spring Publishing.

Healthy People 2020 https://www.healthypeople.gov/

Affordable Care Act https://www.healthcare.gov/

Robert Woods Johnson Affordable Care Act information: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf71997

National Institute on Aging https://www.nia.nih.gov/

National Plan to Address Alzheimer’s Disease https://www.nia.nih.gov/alzheimers/publication/2012-2013-alzheimers-disease-progress-report/national-plan-address-alzheimers

President Obama announces the PMI https://obamawhitehouse.archives.gov/node/333101

President Obama and the Precision Medicine Initiative https://obamawhitehouse.archives.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative

All of Us Precision Medicine Initiative https://allofus.nih.gov/

Team Science  https://www.teamsciencetoolkit.cancer.gov/public/WhatisTS.aspx

Patient Centered Outcomes Research (PCORI) https://www.pcori.org/

Clinical trials https://clinicaltrials.gov/

Murphy, S. V. & Atala, A. (2014). 3-D bioprinting of tissues and organs. Nature Biotechnology, 32(8), 774-85. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25093879

Reichstadt, J., Sengupta, G., Depp, C. A., Palinkas, L. A., & Jeste, D. V. (2010). Older adults’ perspectives on successful aging: Qualitative interviews.  American Journal of Geriatric Psychology, 18(7). 567–575. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3593659/pdf/nihms213379.pdf

Bioprinter attribution:  Attribution not legally required.  From By Андрей Ильин [CC0 or CC0], via Wikimedia Commons. https://upload.wikimedia.org/wikipedia/commons/5/55/Printer_3D_Bioprinting_Solutions.jpg

Tissue printing schematic attribution:

Centromere121 (https://commons.wikimedia.org/wiki/File:Organ_printing_Step_1-2-3.png), Organ printing Step 1-2-3, https://creativecommons.org/licenses/by-sa/3.0/legalcode