The percentage of the population
that will be “elderly” is rising fairly dramatically. In 1900 only four percent
of the population was over 65 and only one percent over 75. By 1950 it was
eight and three percent, respectively. By 2000 it was thirteen and five percent
and now it’s about fourteen and six percent. By 2030 it will be substantially
There are many different concepts
about aging but for our purposes we’ll consider aging gracefully or perhaps
aging wisely. Most people would prefer to have a long life with the proviso
that it is with good health while having some element of fun along the way.
That will be the theme of these articles.
Older individuals have multiple
age related impairments and they tend to have multiple chronic illnesses. The
care of these illnesses is all too often far from ideal. America has the
resources but healthcare delivery is dysfunctional at best. And of course we
know that health care costs are very high. One of the keys is really good
comprehensive primary care which all too many Americans just do not have. The
other key is lifestyle modifications; I’ll deal with the latter in some detail in
the articles to follow.
As we age, sort of like a car, “old
parts wear out.” Most organ functions decline by about one percent per year. Of
course there is great variation in this but that is a pretty good average. The
decline starts at about age forty and probably much earlier and continues
throughout life. Fortunately most of our organs have a huge redundancy and so
we can afford these declines without any level of illness. But at some point
the decline may get to the point where we have a functional impairment that can
Hearing decline begins at about
age 25 but is not noticed until much later.
Many will need reading glasses by age 40 even though having excellent
vision for years; cataracts will occur later.
Balance, often not noticed until later, starts its inevitable decline early
as well. Meanwhile internal organs including heart, lungs and kidneys are
slowly declining and so too is brain function, especially cognition.
This normal aging process of old
parts wearing out is universal, is progressive, and is irreversible, at least
as we know of it today. Let’s use bone mineral density (BMD) as an example. BMD
is easily measured to demonstrate the sturdiness of our bones – how strong they
are. We start out in life with cartilage rather than bones but as we grow as toddlers,
then as children, then as teenagers, calcium and other minerals along with a
protein-collagen matrix are laid down in our bones and they become increasingly
strong reaching a peak at around the age of twenty. Once that age and that peak
are reached it can’t go up any further – that’s it. Then there is a plateau and
at about age forty it starts to decline at the one percent per year rate. Since women tend to live longer
than men, in total more women than men will have a fracture at some point in
their lives. We might just say that is one of the risks of living longer.
age twenty men’s bone mineral density is, on average, higher than women’s.
Nevertheless for women as for men the decline is about one percent per year.
Menopause changes this; the rate of loss increases to perhaps three percent per
year for a few years and then returns again to the one percent average decline
until reaching osteopenia and then osteoporosis. There are three important
points to be made here. If we live long enough, our bone mineral density will
decline to a level where if we fall a bone fracture becomes more likely. Since
women start at a lower level and because they have this increased loss of BMD
during menopause they’ll reach that fracture threshold in life earlier than
Cognitive function is another
example; our brain loses some of its abilities as we age. This loss of cognitive function over time
should not be confused with the disease Alzheimer’s. Nearly everyone who lives
long enough will suffer from some cognitive decline but only some will develop
the disease known as Alzheimer’s. As with BMD, we reach our peak cognitive
function around age twenty; it plateaus for about ten years and then starts the
slow decline. Given the great redundancy in our brains, it is not noticeable
for some time. [Figure modified from Science Magazine] Eventually we reach a
functional threshold where our cognitive function begins to impair our ability.
This becomes more apparent when an older person is engaged in highly technical
activity, in very fast paced activities, or in stressful situations (emotional,
physical or health related). Those challenges to cognition are less apparent
when in highly familiar situations.
Muscle mass and strength decline
in a similar fashion resulting in sarcopenia. Most people lose perhaps 30% of
their muscle mass between ages 50 and 70. [Figure modified from the Buck
Institute] Individuals that exercise find it takes more effort to maintain
their muscle mass and strength but regular exercise and good nutrition have a
significant beneficial impact.
This loss of about 1% per year is
normal. In the following post, I will look at some of the proposed
mechanisms for the aging process and then turn to how to overcome them.