Aging process

• Older adult age groups

  • youngest-old (65-74 y)
  • middle-old (75-84 y)
  • oldest-old (≥85 y)
• Lifespan

  The time from birth to death, an often-measured ageing proxy
• Longevity

  Relatively long lifespans, combining a variety of specific definitions
• Some long-lived people, especially centenarians, experience delayed onset of age-related diseases, with compression of morbidity into a smaller proportion of their lifespans.
• The disposable soma theory is consistent with the current consensus that ageing results from the accumulation of unrepaired cellular and molecular damage.
• Genomic structure and function (DNA repair, nuclear architecture, fidelity of DNA replication) are important when talking about ageing.
• Segmental progerias are genetic diseases that exhibit many clinical manifestations similar to those that develop with ageing but that manifest earlier in life.
• The hallmarks of ageing include genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, and mitochondrial dysfunction.
• Cellular senescence

  In young organisms, cellular senescence prevents the proliferation of damaged cells, thus protecting from cancer and contributing to tissue homeostasis. In old organisms, the pervasive damage and the deficient clearance of senescent cells result in their accumulation, and this has a number of deleterious effects on tissue homeostasis that contribute to aging.
• Altered intercellular communication


  Examples of altered intercellular communication associated with aging.
• The emerging picture from genetic studies of human ageing supports the hypothesis that ageing is driven by the balance of damage and repair processes.
• There is genetic evidence for the importance of several damage pathways in humans.
• Intrinsic capacity


  The combination of the individual's physical and mental (including psychological) capacities.
• Functional ability

  The health-related attributes that enable people to be and to do what they have reason to value. It is made up of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics.
• Intrinsic capacity and functional ability do not remain constant but decline with age as a result of underlying diseases and the ageing process.
• Decline in function and intrinsic capacity is neither linear nor consistent, and it is only loosely associated with a person's age in years.
• Resilience

  The ability to maintain or improve a level of functional ability in the face of adversity (either through resistance, recovery or adaptation). This ability comprises both components intrinsic to each individual (e.g., psychological traits that help an individual frame problems in a way that can lead to a positive outcome, physiological reserves that allow an older person to recover quickly after a fall) and environmental components that can mitigate deficits (e.g., strong social networks that can be called on in times of need, or good access to health and social care).
• Healthy ageing starts at birth with our genetic inheritance. Gene expression can be influenced by experiences in the womb, and by subsequent environmental exposures and behaviours.
• Personal characteristics include those that are usually fixed (sex and ethnicity) and those that have some mobility or reflect social norms (occupation, educational attainment, gender, or wealth). These contribute to our social position within a particular context and time, which shapes the exposures, opportunities and barriers we face, as well as our access to resources.
• Whether older people can achieve the things that they have reason to value will be determined the health status and its interactions with the environments they inhabit at a particular point in time.
• A prevalence of negative environmental factors generates, both in the short- and long-term, dysfunctions and damages in multiple organs leading to increased frailty and vulnerability, disability, high morbidity and mortality.
• Conversely, a positive balance due to the prevalence of protective factors (mainly a healthy diet, a safe environment, lower levels of pollution and regular physical activity) increases health span.
• Things that older people identify as important to have

  • a role or identity
  • relationships
  • the possibility of enjoyment
  • the potential of personal growth
  • security
  • autonomy
• Health

  A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
• Disease

  An abnormal condition that affects the structure or function of part or all of the body and is usually associated with specific signs and symptoms.
• Ageing is not a disease.
• Consequences of the declining intrinsic capacity observed in ageing

  • Cognitive impairment & depressive symptoms
  • Visual impairment and hearing loss
  • Mobility loss
  • Malnutrition
• Mobility loss

  Muscle mass tends to decline with increasing age, and this can be associated with declining strength and musculoskeletal function. Mobility in older adults can be assessed with the SPPB, Tinetti, one-leg balance, BBS, TUG, 400m-WT, or 6-MWT.
• Malnutrition

  Often manifests as reduced muscle and bone mass, and it increases the risk of frailty. Malnutrition has been related to reduced cognitive function, diminished ability to care for oneself, and a higher risk of becoming care dependent.
• Muscle mass

  • Tends to decline with increasing age
  • Can be associated with declining strength and musculoskeletal function
• Mobility assessment tools for older adults

  • SPPB
  • Tinetti
  • One-leg balance
  • BBS
  • TUG
  • 400m-WT
  • 6-MWT
• Malnutrition often manifests as reduced muscle and bone mass, and it increases the risk of frailty
• Malnutrition has been related to reduced cognitive function, diminished ability to care for oneself, and a higher risk of becoming care dependent
• Contemporary malnutrition mortality rates represent a historical high. Effective interventions are needed
• Worldwide, more than 180 million people over 65 years of age have hearing loss that interferes with understanding normal conversational speech
• Severe visual impairment is highly prevalent in people over 70 years of age, and a leading cause of blindness in high-income and upper-middle-income countries
• Worldwide, 46.8 million older people are living with dementia. This number is expected to double every 20 years, reaching 74.7 million in 2030
• Mild cognitive impairment

  The cognitive deficit is less severe than in dementia, and normal daily function and independence are generally maintained
• Mild cognitive impairment is a precursor to dementia in up to a third of cases
• Subthreshold depression

  Affects nearly 1 in 10 older adults and has a major impact on their quality of life