The NEW ENGLAND JOURNAL OF MEDICINE October 1, 2020 Volume 838;14 pp1293-1296 A Half-Century of Progress in Health: The National Academy of Medicine at 50 “Health in Aging-Past, Present, and Future by Linda P. Fried, M.D., M.P.H. and John W. Rowe, M.D.
Over the last 50 years life expectancy at age 65 has increased about 4 years. Advances since 1970 “have involved elucidating the fundamental process of aging and the changes that accompany it.” Especially important are advances relating “geriatric conditions such as frailty, falls and delirium.” A key has been “differentiating disease from aging” at the “molecular, cellular, and system-regulation levels.” Findings suggest factors promoting longevity include; caloric restriction, rapamycin, deletion of senescent cells and activation of sirtuins. We look forward to clinical trials to identify effective prevention and treatment strategies. We also have come to know that “environmental, socioeconomic, and behavioral modifiers of population health” influence “health span”
“’Geroscience’ now covers basic molecular and cellular science; the physiology of aging and related clinical conditions and risks.” “Effective care at the far end of the continuum of needs is now understood” with Alzheimer’s disease care as an example. We now better understand that what were once considered “common clinical findings” are rather than “normal aging” actually “important risk factors that require management and that there is an opportunity for prevention.” Successful examples are the reduction in death from cardiovascular disease and systolic hypertension-which previously was left untreated in the elderly.
There’s a recognition now that “chronic diseases have shared risk factors and that having multiple coexisting medical conditions strongly influences people’s health trajectories, disability, and the complexity of required care.” The best news 2244 reads from this Perspective article in the NEJM article is “With the recognition that increasing age is associated with increased physiological, functional and behavioral heterogeneity and that some people continue to function at a high level into late life.” 2244 concurs with this observation and appreciates an emerging scientific confirmation.
“With the 65-and-older age group approaching 20% of the U.S. population” we need more professionals focused on geriatric medical and geriatric psychiatry. The ultimate goal is to “compress the average period of disease and disability so that our health span approximates our longer life expectancy.” We need to reconsider “our traditional life-course plans” in a mutually beneficial way for “enabling society to benefit from older people’s capabilities and goals” including more opportunities “to participated meaningfully in the labor force and roles contributing to the public good, reconceiving education as a lifelong experience.”