According to Dr. Marie Bernard, deputy director of the National Institutes of Health’s National Institute on Aging (NIA), “We’ve had a significant increase in lifespan over the last century. Now if you make it to age 65, the likelihood that you’ll make it to 85 is very high. And if you make it to 85, the likelihood that you’ll make it to 92 is very high. So people are living longer, and it’s happening across the globe.”
Indeed, research has shown that by incorporating healthy behaviors and staying active, one can now expect to live into their 60s, 70s, and beyond. But why? First and foremost, we now have a strong understanding of the important role that diet, exercise, and other healthful behaviors can play in mitigating some of the negative effects associated with genetic history. In addition, we have greatly expanded the role of preventive medicine and have achieved dramatic advances in the treatment of many diseases and conditions associated with advancing age, such as hypertension, diabetes, high cholesterol, heart disease, and certain cancers. But perhaps the most important contributing factor to expanding lifespans is our understanding of the ways in which social determinants of health intersect with biological, genetic, physical, emotional, cognitive, and environmental aspects of aging in the United States. These are the factors that, according to the World Health Organization, are influenced by the economics, power, and resources at global, national, and local levels. These so-called “structural determinants of health inequities” encompass such issues as socioeconomic and employment status, educational level, stress and coping behaviors, substance use disorders and mental illness, food and nutrition, housing and transportation, and the impact of social support or isolation.
- Unusual disease presentations
- Increased comorbidities
- Increased incidence of illnesses related to medical treatment
- Changes in functional ability and difficulties with activities of daily living
- Increased importance of social and caregiving support
- Lack of appropriate diagnoses and interventions for emotional issues such as depression, and cognitive issues such as delirium, dementia, or memory impairment
Further complicating the attainment of optimal outcomes in the aging patient are other key concerns such as a shortage of geriatric professionals, an overreliance on (often unsupported) family caregivers, and the prevalence of economic insecurity for older adults, coupled with increasing challenges for Medicare and Medicaid coverage.
Certainly, the trials associated with aging are significant, but the tools we now possess to meet these challenges have never been as informed or advanced as they are today. The driving mission then becomes how to better understand what happens to our bodies and minds as we age, coupled with environmental factors, genetics, and disease-specific processes, and to apply what we learn to improve functional health, reduce the risks of disease, and facilitate the highest quality of life possible. To bring this new perspective on healthy aging into focus, NIA is committed to expanding the science and dynamics of aging, and furthering its vision “…to enable all Americans to enjoy robust health and independence with advancing age.” As the recognized U.S. leader in research on aging and Alzheimer’s disease, NIA oversees an expansive scientific agenda that aims to understand the multidimensional nature of aging and to extend the healthy, active years of life.
NIA has developed the document Aging Well in the 21st Century, which outlines their strategic approach to developing research priorities, and maintaining and refining their scientific portfolio. This comprehensive and dynamic plan provides a detailed overview of NIA’s three primary commitments, which are (1) Understanding the Dynamics of the Aging Process; (2) Improving the Health, Well-Being, and Independence of Adults as They Age; and (3) Supporting the Research Enterprise. Further, it delineates eight key goals within these three areas that serve to shape the Institute’s ongoing work. These goals are:
- Goal A: Better understand the biology of aging and its impact on the prevention, progression, and prognosis of disease and disability.
- Goal B: Better understand the effects of personal, interpersonal, and societal factors on aging, including the mechanisms through which these factors exert their effects.
- Goal C: Develop effective interventions to maintain health, well-being, and function and prevent or reduce the burden of age-related diseases, disorders, and disabilities.
- Goal D: Improve our understanding of the aging brain, Alzheimer’s disease, and other neurodegenerative diseases. Develop interventions to address Alzheimer’s and other age-related neurological conditions.
- Goal E: Improve our understanding of the consequences of an aging society to inform intervention development and policy decisions.
- Goal F: Understand health disparities and develop strategies to improve the health status of older adults in diverse populations.
- Goal G: Support the infrastructure and resources needed to promote high-quality research.
- Goal H: Disseminate information to the public, medical and scientific communities, and policymakers about research and interventions.
In future posts, I will take a closer look at each of these three areas and explore the research, actions, and interventions that are being developed to ensure that healthy aging can be an achievable reality for us all.