Oct. 01 2020

Our Experts Review a Half Century of Progress on Aging

A new article in the New England Journal of Medicine reviews scientific progress in understanding aging in the 50 years since the founding of the Institute of Medicine (now called the National Academy of Medicine). The Perspective article by renowned aging scholars Dean Linda P. Fried and John Rowe points to promising developments in aging science, medicine, and public health, yet argues that society must reimagine life-stage roles to capitalize on the contributions of older people for the good of all.

Over the last half century, life expectancy for people 65 years of age in the United States has increased by one month per year, on average, and soon there will be more Americans over age 65 than under age 15.

Fried, who is Dean of Columbia University Mailman School of Public Health and director of the Columbia Aging Center, and Rowe, the Julius B. Richmond Professor of Health Policy and Aging at Columbia Mailman School, innumerate key advances in the science of aging—the identification of biomarkers of aging and age-related disorders; the exploration of aging at the molecular, cellular, and system-regulation levels; as well as potential ways to extend healthy lifespans. The article includes a timeline of milestones in basic science, medicine, as well as population and public health science, and social and behavioral science.

Importantly, this research has helped differentiate aging processes from disease. Health conditions once considered to reflect “normal aging” now represent important risk factors that require management. One consequence has been that mortality due to cardiovascular disease has been reduced dramatically in even the oldest age group.

Recent years have also seen a shift from a focus on individual diseases to recognition that several 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. Scientific advances have led to definitions of common geriatric syndromes and clarification of their import—notably, falls, frailty, and delirium.

“There is now strong evidence supporting both prevention and treatment of these syndromes, which can substantially affect quality of life,” Fried and Rowe write. “Interventions targeting multiple risk factors, from fall-prevention efforts to senior volunteer programs, have shown success in promoting health and preventing physical and cognitive decline. … The evidence indicates that it’s possible—with public health interventions, medical care, education, economic security, and supportive environment—to compress the average period of disease and disability so that our health span approximates our longer life expectancy.”

Of course, not everyone ages in the same way. Cumulative accrual of health threats associated with disadvantage, especially at critical life periods, drive health disparities in late life, the authors write. Moreover, the climate crisis adds new threats to health in old age, from heat stress, drought, and food insecurity to smoke inhalation from wildfires, to a growing necessity for migration—threats likely to worsen these disparities. On the positive side, aging is now understood to be much more than a process of losses and dependency—it is a part of life that includes acquisition of valuable cognitive and psychosocial capabilities.

The authors conclude by arguing that, given the global emergence of aging societies, nations must reengineer their core institutions, such as work, education, health care and retirement to support healthy aging in progressively longer lives. “With healthy older people bringing unprecedented social capital, societies would receive a demographic dividend from longer lives, as the assets contributed by older adults support better lives for younger people now and in the future,” they write.