Healthy Aging In a New World
The pace at which the population is ageing is much faster today than in the past. People worldwide are living longer. Today, most people can expect to live into their sixties and beyond. Every country in the world is experiencing growth in both the size and the proportion of older persons in the population. By 2030, 1 in 6 people in the world will be aged 60 years or over.
All countries are now facing major challenges in ensuring that their health and social systems are ready to make the most of this demographic shift. Between 2015 and 2050, the proportion of the world’s population over 60 years is expected to nearly double from 12% to 22%. It is also predicted that 80% of older people will be living in low- and middle-income countries. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million. While this shift in distribution of a country's population towards older ages – known as population ageing – started in high-income countries (for example in Japan 30% of the population is already over 60 years old), it is now low- and middle-income countries that are experiencing the greatest change. By 2050, two-thirds of the world’s population over 60 years will live in low- and middle-income countries.[4]
Every person – in every country in the world – should have the opportunity to live a long and healthy life. However, the environments in which one lives can either favor health or be harmful to it. Environments are highly influential on people behaviour as they provide exposure to health risks (for example, air pollution, violence etc), determine the access to quality health and social care and the opportunities that ageing brings. This makes healthy aging an intricate subject as it is affected by a variety of variables, some which are in our control and some which are not in our control. It is a complex phenomenon that involves a lifelong process and depends on the sustained, efficient ability to maintain good health in the elderly. The population demography across the globe is showing an increasing trend in the ageing population due to better healthcare, improved nutrition, advanced health-related technology, and decreased fertility rate.
Healthy aging is defined as a continuous process of optimizing opportunities to maintain and improve physical and mental health, independence, and quality of life throughout the life course.
WHO defines healthy ageing as the process of developing and maintaining the functional ability that enables well-being in older age. The functional ability is determined by the intrinsic capacity of an individual, the environments in which he or she lives and the interactions among them. In general, active aging recognizes the factors affecting individuals' actions in their daily lives. Active and Healthy Ageing (AHA) aims at enhancing people's overall quality of life (as they get older) by improving areas such as health and long-term care, participation in employment and in society, or physical security and financial stability, etc.[2]
Healthy ageing is about creating the environments and opportunities that enable people to be and do what they value throughout their lives. Everybody can experience healthy ageing. Being free of disease or infirmity is not a requirement for healthy ageing, as many older adults have one or more health conditions that, when well controlled, have little influence on their wellbeing. Healthy ageing is currently the focus of WHO’s work on ageing between 2015 – 2030, as it has replaced the previous focus on active ageing, a policy framework developed in 2002. Healthy ageing, like active ageing, emphasizes the need for action across multiple sectors and enabling older people to remain a resource to their families, communities and economies. [2]
At the biological level, ageing results from the impact of the accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease and ultimately death. These changes are neither linear nor consistent, and they are only loosely associated with a person’s age in years. The diversity seen in older age is not random. Beyond biological changes, ageing is often associated with other life transitions such as retirement, relocation to more appropriate housing and the death of friends and partners.
Aging can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility. The characteristics of aging—as distinguished from diseases of aging (such as cancer and heart disease)—affect all the individuals of a species.
The major factors/causes of aging include (and are not limited to):
a) Oxidative Stress: This is an imbalance between antioxidant defenses and free radicals in one’s body causes oxidative stress. This can lead to disease or inflammation. There are many factors that could lead to oxidative stress, such as lack of exercise, obesity, poor diet, smoking, drinking alcohol, taking certain medicines, exposure to environmental factors such as radiation, toxins, air pollution, pesticides, and sunlight. 8-hydroxydeoxyguanosine (8-OHdG) is probably the most commonly used DNA damage marker for oxidative stress.
b) Glycation: Glycation refers to the irreversible binding of glucose with proteins and lipids. It is a chemical reaction mainly caused by the excess sugar one ingests. Some foods are high in glycation, including meat (especially red meat), certain cheeses, fried eggs, butter, cream cheese, margarine, mayonnaise, oils, and nuts.
c) Telomere Shortening: Telomeres are structures made from DNA sequences and proteins found at the ends of chromosomes. They cap and protect the end of a chromosome like the end of a shoelace. In almost all animals, from the simplest to the most complex, telomeres are required for cell division. The main function of a telomere is to maintain chromosomal stability and prevent chromosomal degradation. An enzyme named telomerase adds bases to the ends of telomeres. In young cells, telomerase keeps telomeres from wearing down too much. But as cells divide repeatedly, there is not enough telomerase, so the telomeres grow shorter and the cells age.
d) Chronological Age: Chronological age is how long one has existed. Biological age is how old one cells are. Sometimes these two numbers are the same for people, but everyone ages at different rates. Understanding the difference between cognitive age and biological age is crucial as the world's population ages. While "biological age" refers to a person's age chronologically based on their birthdate, "cognitive age" relates to their mental or cognitive capacities.
Common conditions in older age include fatigue, memory loss or brain fog, muscle and/or joint pain, wrinkles, gray hair, headache, hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia. As people age, they are more likely to experience several conditions at the same time. Older age is also characterized by the emergence of several complex health states commonly called geriatric syndromes. They are often the consequence of multiple underlying factors and include frailty, urinary incontinence, falls, delirium and pressure ulcers.[7]
Factors Influencing Healthy Ageing
A longer life brings with it opportunities, not only for older people and their families, but also for societies as a whole. Additional years provide the chance to pursue new activities such as further education, a new career or a long-neglected passion. Older people also contribute in many ways to their families and communities. Yet the extent of these opportunities and contributions depends heavily on one’s health. Evidence suggests that the proportion of life in good health has remained broadly constant, implying that the additional years are in poor health. If people can experience these extra years of life in good health and if they live in a supportive environment, their ability to do the things they value will be little different from that of a younger person. If these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are more negative. Although some of the variations in older people’s health are genetic, most is due to people’s physical and social environments – including their homes, neighborhoods, and communities, as well as their personal characteristics – such as their sex, ethnicity, or socioeconomic status. The environments that people live in as children – or even as developing fetuses – combined with their personal characteristics, have long-term effects on how they age.[8]
Physical and social environments can affect health in various ways. Some effects are direct, and some are through barriers or incentives that affect opportunities, decisions and health behavior. Maintaining healthy behaviors throughout life, particularly eating a balanced diet, engaging in regular physical activity and refraining from tobacco use, all contribute to reducing the risk of non-communicable diseases, improving physical and mental capacity and delaying care dependency. Supportive physical and social environments also enable people to do what is important to them, despite losses in capacity. The availability of safe and accessible public buildings and transport, and places that are easy to walk around, are examples of supportive environments.
However, there are challenges to a healthy ageing population. In developing a public-health response to ageing, it is important not just to consider individual and environmental approaches that ameliorate the losses associated with older age, but also those that may reinforce recovery, adaptation and psychosocial growth.[8]
Challenges In Responding To Population Ageing
There is no typical older person. Some 80-year-olds have physical and mental capacities similar to many 30-year-olds. Other people experience significant declines in capacities at much younger ages. A comprehensive public health response must address this wide range of older people’s experiences and needs. The diversity seen in older age is not random. A large part arises from people’s physical and social environments and the impact of these environments on their opportunities and health behaviour. The relationship one has with his/her environments is skewed by personal characteristics such as the family he/she was born into, sex and ethnicity, leading to inequalities in health.[9]
Older people are often assumed to be frail or dependent and a burden to society. Public health professionals, and society as a whole, need to address these and other ageist attitudes, which can lead to discrimination, affect the way policies are developed and the opportunities older people have to experience healthy aging. Globalization, technological developments (e.g., in transport and communication), urbanization, migration and changing gender norms are influencing the lives of older people in direct and indirect ways. A public health response must take stock of these current and projected trends and frame policies accordingly. [9]
Major Implications[10]
a) The Decline in the Working-Age Population: A rapidly aging population means there are fewer working-age people in the economy. This leads to a supply shortage of qualified workers, making it more difficult for businesses to fill in-demand roles. An economy that cannot fill in-demand occupations faces adverse consequences, including declining productivity, higher labor costs, delayed business expansion, and reduced international competitiveness. In some instances, a supply shortage may push up wages, thereby causing wage inflation and creating a vicious cycle of price/wage spiral. To compensate, many countries look to immigration to keep their labor forces well supplied.
b) Increase in Health Care Costs: Given that demand for healthcare rises with age, countries with rapidly aging populations must allocate more money and resources to their health care systems. Healthcare spending as a share of gross domestic product (GDP) is already high in most advanced economies; one challenge that advanced economies face is to ensure that when they increase spending, healthcare outcomes actually improve. The healthcare sector also faces labor and skills shortages and increased demand for at-home care. All of these cost escalators can make it more difficult for existing systems to handle the increased prevalence of chronic diseases, while also addressing the needs of large and growing populations of older adults.
c) Increase in Dependency Ratio: Countries with large populations of older adults depend on smaller pools of workers from which to collect taxes to pay for higher health costs, pension benefits, and other publicly funded programs. This is becoming more common in advanced economies where retirees live on fixed incomes with much smaller tax brackets than workers. The combination of lower tax revenue and higher spending commitments on health care, pensions, and other benefits is a major concern for advanced industrialized nations.
Many industrialized nations are grappling with aging populations. These often correspond with a decline in working-age adults and a rise in health care costs. These issues can cause economic strains, particularly when it means that a smaller proportion of the total population has to bear significant social safety net costs. Countries are currently exploring a number of different policies to adapt to economic shifts due to aging populations. A common proposal set forth includes delaying the age of retirement, which effectively lengthens the amount of time that individuals spend working. Other possibilities include decreasing social security benefits, in cases where there are potential deficits, and increase taxes to pay for them.
Yet, these issues will not be easily resolved. Simple solutions such as incentivizing families to have more children is not working. Social influences, economic uncertainty and greater access to education has delayed marriage and children. According to one research, in some countries, the childbearing age has been rising steadily over the past few years. In 2000, it was 26 and as of 2022, it was 29. When those children grow up, they opt to live in cities and take knowledge worker roles, leaving crucial farm and factory jobs open or filled by an ageing workforce that can’t afford to retire due to small pensions. Second, the talent shortage of medical professionals is getting acute. According to the World Bank, there are 4 doctors per thousand people in Western European countries and 2.7 in the US. Comparatively in China, there are 2 doctors per thousand people. While predicting the effects of these challenges can be tricky. A rising ageing population combined with a housing market bubble may result in a decade of flat economic growth followed by deflation. To mitigate the impacts of aging populations on economies, the countries can be strategic in the use of technology by investing in solutions that allow them to look after the ageing population in the following ways:
Proactively Monitor Health And Detect Potential Changes: For example, medical sensors can provide the necessary insight for caregivers to take action quickly while ensuring the privacy of individuals. The use of wall-mounted sensors at a senior care facility in the US led to preventing an estimated 400 potential falls and faster response times, under 30 seconds, when a fall did occur. This approach helps address issues before they become medical emergencies. According to the Centers for Disease Control (CDC), the amount spent on medical costs as a result of patient falls is $50 billion a year in the US alone. These costs can easily be offset through proactive monitorin.
Ensure Reliable Access To Telehealth: To support the elderly in remote rural communities, there should be stable, low-cost internet access to provide telehealth services.
Incentivize home improvements and technology investments: To support loved ones ageing with privacy and dignity, either independently or with loved ones.
Establish the infrastructure that allows younger generations to properly care for the elderly. This includes:
Encourage and support younger generations to look after the elderly, for example, support caregivers and motivate volunteers in the workplace by providing flexible work arrangements without fear of job loss or career setbacks.
Introduce students to career opportunities in senior care earlier to enable recruiting new workers with elevated pay and additional incentives to fill these much-needed roles. Additionally, establish relevant disciplines and training in universities and vocational educational institutions.
The acceptance of aging is essential to one’s physical and emotional well-being. If one fixates on getting old, he/she is more likely to overcompensate by exercising too much or embarking on diets that may do more harm than good. By accepting aging as a process over which people have some control, one can make healthy choices whether he/she is of any age.
Aging cannot be avoided. However, several things one can do to mitigate the environmental factors that influence aging:[13]
Eat well: Added sugar, salt, and saturated fat wreak havoc on the body, increasing the risk of hypertension, diabetes, and heart disease. To avoid these aging-related concerns, increase your intake of fruits, vegetables, whole grains, low-fat dairy, and lean meat and fish.
Read labels: If one has to buy packaged foods for convenience, check the label to ensure that one must limit sodium intake to under 1,500 milligrams (mg) per day, sugar intake to around 25 mg per day, and saturated fat intake to less than 10% of daily calories intake.
Stop smoking: Quitting cigarettes improves circulation and blood pressure while drastically reducing the risk of cancer. Though it often takes multiple quit attempts to finally kick the habit, there are effective cessation aids that can help.
Exercise: Try to meet the recommended exercise requirements for good health (roughly 30 minutes of moderate to strenuous exercise 5 days per week). Even so, 15 minutes of moderate activity per day can improve longevity compared to no exercise.
Socialize: Socialization keeps one psychologically engaged and may help influence longevity as well. Maintain good, healthy relationships with others. Stay connected to the people, one loves, and try to meet new people.
Get ample sleep: Chronic sleep deprivation is linked to poorer health and shorter life spans. By improving sleep hygiene and getting around 7 to 8 hours of sleep per night, may not only feel better but live longer.
Reduce stress: Chronic stress and anxiety can be damaging to the human body as they trigger the release of an inflammatory stress hormone called cortisol. Control stress with relaxation techniques and mind-body therapies to help alleviate the indirect inflammatory pressure placed on cells.
The maintenance of Quality Of Life (QoL) among older adults is necessary from individual to family, society, and healthcare perspectives. The aging population should not be solely viewed as a potential economic crisis. Rather, it’s a call to reinforce or create new infrastructures – economically, socially, and technologically – that respect and care for the generations that come before. After all, they are the ones who have brought forth innovation and prosperity to the next generations. By taking the right steps today, countries’ younger populations will be fortunate enough to share meaningful experiences with grandparents and older generations living nearby, independently, while carrying on individual traditions.
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