Jeanne Calment February 21, 1875 - August 4, 1997

Equality and the Life Course
23 June 2009
The Future of Ageing
Tom Kirkwood
Institute for Ageing and Health
Newcastle University
Key Questions about Ageing
• Why does ageing occur?
• Is there a limit to the human life span?
• Does increasing longevity mean an
inevitable population explosion?
• Do longer lives mean more diseases?
• Can we afford increasing life spans?
Within the US, the economic benefit
of the increase in life span since 1970
is estimated to have been worth
$73,000,000,000,000.
The Continuing Increase in Life Expectancy
UN estimate 2000
UN estimate 1990
UN estimate 1980
Oeppen & Vaupel Science 2002
Declining early/mid-life mortality Declining later-life mortality
What happened? Why??
Ageing – Historically a Rarity, Now Routine
Then
20
40
60
80
Now
The “Disposable Soma”
Age
Implications of the Disposable Soma
 We are not programmed to die.
 We are programmed for survival but in our
ancestral environment investments in
reproduction were a higher priority than longterm survival.
 Ageing is caused by the build-up of faults.
From One Cell to 100 Million Million
50 cycles of (photo-)copying
Mitochondrial Mutations in Human Colon
Taylor et al J Clin Invest 2003
Telomere Erosion, Stress and Health
•Telomeres protect chromosome ends – they shorten with
cell division and this is accelerated by biochemical stress.
• Prematurely short telomeres are linked with increased risk
of age-related disease and diminished survival.
•People suffering severe chronic stress (eg carers of those
with dementia and other conditions) have shorter telomeres.
The Ageing Process
Age-related Frailty, Disability, and Disease
ANTI-INFLAMM.
INFLAMMATION
Accumulation of Cellular Defects
GOOD
LIFESTYLE
GOOD
FOOD
Random Molecular Damage
STRESS
ENVIRONMENT
BAD
FOOD
Human Ageing is Malleable
 By decreasing exposure to damage
– Improved nutrition
– Improved lifestyle
– Improved environment
 By enhancing natural mechanisms for
protection and repair
– Improved nutrition
– Novel drugs, stem cells, etc
Multi-Stage Progression of Age-Related Disease
Disease B
Disease A
Disease C
„Upstream‟
„Downstream‟
What Accounts for the
Individuality of Human
Ageing?
Heritability of Human Longevity Twin Studies
Coefficient of heritability
McGue et al (1993)
Herskind et al (1996)
Ljungquist et al (1998)
0.22
0.25
<0.33
Genes account for about 25% of what determines longevity
Factors Influencing Longevity and Health Span
 Genes
 Nutrition
• High intakes of vegetables, fruits
and cereals.
• Moderate to high intake of fish.
• Low intake of meat.
• Low intake of saturated fatty
acids.
• High intake of monounsaturated
fatty acids (olive oil).
• Low to moderate intake of dairy
products, principally cheese and
yoghurt.
• Modest intake of alcohol (mostly
wine).
EPIC-elderly Study Protocol
76,707 men and women aged 60+
No CHD, stroke or cancer at
enrolment
Median follow up 89 months
(4047 deaths)
Adherence to Mediterranean diet
assessed on 10-point scale:
0 (poor)…9 (high)
2 unit increment results in 8% reduction of overall mortality
Trichopoulou A et al. (2005) BMJ 330, 991-997
Factors Influencing Longevity and Health Span
 Genes
 Nutrition
 Lifestyle
The Benefits of a Healthy Lifestyle
Factors Influencing Longevity and Health Span
 Genes
 Nutrition
 Lifestyle
 Socioeconomic status
Wealth and Expectation of Life
Source: TH Hollingsworth, quoted in J Cairns,
Matters of Life and Death, 1997
Factors Influencing Longevity and Health Span
 Genes
 Nutrition
 Lifestyle
 Socioeconomic status
 Environment
The Importance of Environment
 Environment can have powerful enabling or
disabling impacts on older age.
 Unsupportive environments (poor transport
housing, crime, etc) discourage active lifestyle
and social participation.
 Inactivity and isolation accelerate physical and
psychological declines.
 Attitudes are key features of the environment.
 Attitudes are informed by the cultural milieu
(literature, film, media, political discourse,
education, etc)
The Life Course Trajectory of Mental Capital and Wellbeing
Government Office for Science - Foresight: Mental Capital and Wellbeing Project.
“Mental Capital Through Life: Future Challenges”, Kirkwood et al 2008
Key Questions about Ageing
• Why does ageing occur?
• Is there a limit to the human life span?
• Does increasing longevity mean an
inevitable population explosion?
• Do longer lives mean more diseases?
• Can we afford increasing life spans?
Age Transitions and their Management
 The moving boundary of old age
 Changing self-image
 Changing health
 Changing attitudes
 Work and beyond
 Education and challenge
 Fighting and accepting functional decline
 Avoiding traps
 Winning the end-game
Barriers to Changing the Status Quo
 Fatalism – “I can’t change it anyway”.
 Negative stereotyping – “Old people are losers”.
 Tunnel vision – “This is how it has to be”
 Youth bias – “We must invest in the future!”
 Restrictive accounting of costs and benefits –
“Why should I pay when it’s not me that
benefits?”
 Lack of hard evidence – “I won’t consider it until
it’s proved to work”
 Short-term’ism – “I’ll deal with it when I’ve fixed
the immediate crisis”.
The Traditional View of Ageing
A New View of Age
 The ageing process is biologically determined (we are
programmed to die) with an inbuilt limit to lifespan
We are programmed for survival not death.
 The ageing process is one of progressive, irreversible
loss of functional capacity and of quality of life
Ageing is intrinsically malleable
 Ageing is something that only concerns people in the
later years of life
Youth and age are a continuum
 Increasing human longevity threatens to impose an
intolerable burden on societies around the world
Increasing longevity is a resounding success
bringing major opportunities as well as
challenges.