The challenge of old age.
Text: Reto W. Kressig
We are not only getting older, but also increasingly doing so in good health. Aging can therefore be seen as both an opportunity and a challenge.
The saying “Getting old isn’t for the faint of heart” is attributed to the American movie star Mae West, who lived to the ripe old age of 87. That is not to say that youth and adulthood are without their challenges. Nevertheless, many see seniority as an overpowering adversary that, for lack of courage, they want to avoid confronting for as long as possible.
Whether the fear of aging that exists for many is rooted in cultural, social or religious issues, or is primarily about coming to terms with their own mortality is probably something that everyone has to work out for themselves. Likewise, it should be for everyone to decide whether they want to change where and how they live at a certain age. After all, in many cultures – unlike in ours – old age is held in particularly high esteem. In some, such as Judaism, old age is even considered an almost ideal life situation. In Japan, Respect for the Aged Day has been an official annual holiday since 1966. In the dichotomy between these cultural disparities, people can experience old age – on a philosophical and psychological level – either as an opportunity or as a deficiency.
On average, those aged 80 in Switzerland today are in significantly better health from a biological/medical perspective than people of the same age 20 years ago. Among those born in 1950, 5.3% of men and 9.5% of women are expected to live to the age of 100. Of the generation born in 2013, 17.6% of men and 23.9% of women will probably live to see their 100th birthday. Today, it is assumed that this longevity – which many enjoy in good health – is the result of a healthy lifestyle with a balanced diet, regular physical and mental activity, and consistent monitoring of vascular risk factors.
Indeed, research into healthy aging in particular is currently experiencing a golden age. With over 2,100 participants, the recently completed multicenter “DOHEALTH” study of healthy aging was the largest EU-funded study of the topic to date. The data analysis work is currently running at full steam with a view to revealing the extent to which a simple exercise program and the intake of vitamin D and omega-3 fatty acids can affect the health of seniors over the age of 70 who live in their own home.
A protein-rich diet in old age has already been shown to help preserve muscle mass and strength – which is a very promising finding in terms of mobility in old age but not that easy to implement in everyday life. Finally, there is also scientific evidence that gait steadiness and cognitive fitness benefit significantly from activities such as eurhythmics, dance, or tai chi: a study of participants with an average age of 75 found that such activities reduce fall risk by about half and boost cognitive-motor multitasking ability.
Advances in geriatric medicine
The debate rightly continues as to whether our healthcare system adequately meets the medical needs of older patients with acute illnesses that require hospitalization. Here, it is typically up to family doctors to decide whether an older patient’s acute illness can be treated using classical internal medicine or requires hospitalization in a specialist acute geriatric ward.
Acute geriatric medicine developed from general internal medicine with the addition of specialist training in geriatrics. It has undergone considerable development in recent years and, in the Swiss healthcare system, can provide intensive physiotherapy and early rehabilitation services at the same time as acute treatment. This maximizes functional independence in older patients at risk of functional decline due to acute illness. Course content relating to geriatric medicine has now been included in the university catalog of learning objectives for medical degrees in Switzerland for over ten years and is taught at all universities here.
It is particularly interesting to note that a growing number of young and prospective physicians see themselves specializing in geriatric medicine – and the curve has been rising exponentially for years. In Switzerland, we have now reached a degree of geriatric specialist healthcare coverage that is higher than in the USA. Faced with demographic change, we can only hope that this trend persists.
Modern aging research incorporates countless facets, which reflect the manifold dimensions of later life. Aging is considered from the perspectives of biology, medicine, law, philosophy, ethics, social science, economics, political science, and cultural studies. In light of ongoing demographic changes, these research activities will continue to experience considerable growth.
Medical clinical research on older patients, who are often suffering from multiple illnesses and functional impairments, is extremely complex. This is reflected in, for example, the continuing systematic exclusion of such patients from drug trials. Potential complications are considered too difficult to interpret as well as too fraught with risks and consequences. Nevertheless, once authorized, the same drugs are then also used in the excluded patient groups.
The heterogeneous state of health of many older people makes it hard to find reliable, clinically practicable answers to important questions in clinical research. Modern research into geriatric medicine therefore increasingly resorts to a “frailty” classification in order to homogenize older study populations. This classifies older people, regardless of the number of diagnoses, based on their degree of frailty and existing functional reserves (also referred to as stress resistance). The degree of frailty is based on various health dimensions and allows classification into “fit”, “transitional” or “frail”. The advantage of a study design with a defined degree of frailty is clear: the study’s results can then be implemented much more easily and reliably in the clinical setting.
In this way, the aging society is driving progress in teaching and research in the field of geriatric medicine – which in turn benefits older people. They are not only living longer, but also increasingly doing so in good health. This should provide comfort for the faint-hearted individuals in the quote from Mae West. After all, there is no escaping the fact that aging is the only way to live longer.
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