Age-dependent diseases
Why do people age more slowly?
Olga Tkacheva, Post-science
Age–associated diseases are diseases whose prevalence increases with age: cardiovascular diseases, oncological, dementia, Alzheimer's disease, diseases of the musculoskeletal system, chronic obstructive bronchitis, type II diabetes mellitus. At the age of 35-45, only 33% of people suffer from arterial hypertension. At the age of 65, 75% of people already suffer from arterial hypertension. According to the Framingham study, after 60 years, the chance that a person will increase blood pressure and develop arterial hypertension is 90%. The same story with diabetes mellitus. Diabetes mellitus of the second type in 40 years has only 1.5%, in 65-70 years 20%, but after 80-85 years the risk of developing diabetes mellitus decreases to 4%. This is due to the fact that patients with diabetes do not reach this age. We conducted a study called "the register of centenarians". Their risk of developing diabetes mellitus is extremely low: only 3% of the risk of detecting diabetes mellitus. Diabetes mellitus and longevity are incompatible things, because diabetes mellitus is a model of premature aging.
The whole interest is that the older people are, the less risk they have of getting new diseases. At the age of 110, people practically stop getting sick, but few people live to that age. Infectious diseases, cardiological, cardiovascular catastrophes or oncological problems do not occur in people after 110 years: people are in the zone of negligible aging.
Now let's look at the factors that can reduce the risk of developing diseases. I must say right away that prevention should not begin in old age, but almost in utero. Scientists suggest that the rate of aging is laid even in utero, – the hypothesis of fetal programming. This rate depends on fetoplacental blood flow, the mother's metabolism and her blood pressure. Everything that happens to us before birth then affects the risk of age-associated diseases. The birth of a child with a low weight is a high risk of developing metabolic syndrome and type 2 diabetes mellitus, which act as models of premature aging. When we talk about the effective prevention of age-related diseases, this is the usual prevention, but started earlier. A healthy lifestyle, physical activity, a healthy diet, giving up bad habits – we have no other options today.
Now the development of age-associated diseases is postponed and appears at a late age, so a person lives actively for a longer period of life without serious illnesses. The aging process itself has also slowed down in recent decades. In Europe, studies were conducted where fifty-year-olds were examined in terms of their physical and cognitive activity. One study was conducted in 2005, another study was conducted in 2013, which showed that the biological age of people aged 50 in 2005 corresponded to the biological age of people aged 58 in 2018 in terms of cognitive status. This is due to lifestyle and new technologies.
One of the main age–associated problems is dementia. Alzheimer's disease is observed in 70% of cases, and its prevalence increases with age. Previously, it was believed that everyone would die of Alzheimer's disease if they lived. After the age of 85, one in three suffers from cognitive deficits. Reagan and Thatcher suffered from Alzheimer's disease. The most famous and richest people in the world suffered from Alzheimer's disease, and today they do not know how to treat it, but it is already clear how to prevent the development of this disease. In developed countries, the prevalence of Alzheimer's disease has decreased, despite the fact that life expectancy continues to increase, as well as the aging of the population.
Effective preventive measures are very important to solve the problem of aging. All age-associated diseases have the same trunk, and only then they diverge into different branches. The reason for them is the same – the problem of aging. Scientists are trying to slow down aging. It is believed that if we focus only on cancer prevention, we will increase the population of elderly people by 0.8% within 50 years. If we are engaged in the prevention of aging processes, we will increase the proportion of elderly people by 7%. This strategy is 10 times more effective. It will prevent all age-associated diseases. If prevention has not worked and the disease has developed, then we will deal with treatment strategies. Today, doctors are not very good at treating people whose age reaches 85-90 years, because clinical studies have not been conducted in such patients. People over the age of 85 are usually excluded from the study. Elderly people often have several diseases at once, so they are difficult to investigate. Today, scientists are faced with the task of conducting clinical studies in a cohort of elderly people of different ages and varying degrees of loss of functionality.
Today we understand not only the effect of drugs on specific indicators: for example, an antihypertensive drug can reduce blood pressure. It is important for us how this drug or this strategy will affect walking speed, balance, memory, functionality, ability to live independently, quality of life. Each method of treatment in elderly people needs to be weighed, where is the risk and where is the benefit. Doctors estimate what the life expectancy of this person is, whether he will have time to benefit from this treatment, so scientists face many challenges.
There are two extremes in the treatment of age-associated diseases. One extreme is ageism, when we say that elderly people have so little to live, so they should not be provided with high–tech or complex assistance. High technology should be used in old age. All new, most advanced technologies and medicines should be used in old age. There should be no ageism. 4-5 years ago, we did not imagine that there would be registers of patients with heart failure over the age of 80. Today we have learned how to treat heart failure well using the highest technologies, despite the fact that heart failure is a difficult situation and a syndrome. The prognosis for heart failure is often worse than for the oncological process. Today, these advanced technologies, which we should and can use in old age, allow a person to live longer. There is another extreme – the appointment of all drugs that are associated with all diseases that a person has. This is excessive treatment, when the treatment itself will no longer be beneficial, – polypragmasia. You cannot treat all diseases and prescribe all the medications shown, because there will be dozens of them.
On the one hand – ageism and refusal of treatment, and on the other – excessive treatment. It is difficult to choose the golden mean, but there are many examples. One example is a fracture of the femoral neck in a person aged 80 years. This is an acute coronary syndrome, like a myocardial infarction. We need to operate on this person within 48 hours. This will save his quality of life in the future. Here we should not refuse treatment in any way. There are no contraindications. In another situation, when a person has 15 diseases and we start treating all of them with a complex of necessary medicines, we will simply ruin a person. Here it is necessary to weigh what is risky and what is not. This is difficult for any professional, because today we do not have normal evidence-based clinical studies.
I believe that in the future we will learn how to prevent age-related diseases and aging. We will also be able to slow down the aging process – this is our next step. Today we are studying many medications in terms of how they affect the aging process.
About the author:
Olga Tkacheva – Doctor of Medical Sciences, Professor, Director of the OSP RGNCC RNIMU named after N. I. Pirogov, chief freelance geriatrician of the Ministry of Health of Russia.
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