Friday, September 21, 2018

Normal Aging – A Steady Loss of Organ and Process Function

The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent and now it’s about fourteen and six percent. By 2030 it will be substantially more again.

There are many different concepts about aging but for our purposes we’ll consider aging gracefully or perhaps aging wisely. Most people would prefer to have a long life with the proviso that it is with good health while having some element of fun along the way. That will be the theme of these articles.
Older individuals have multiple age related impairments and they tend to have multiple chronic illnesses. The care of these illnesses is all too often far from ideal. America has the resources but healthcare delivery is dysfunctional at best. And of course we know that health care costs are very high. One of the keys is really good comprehensive primary care which all too many Americans just do not have. The other key is lifestyle modifications; I’ll deal with the latter in some detail in the articles to follow. 

As we age, sort of like a car, “old parts wear out.” Most organ functions decline by about one percent per year. Of course there is great variation in this but that is a pretty good average. The decline starts at about age forty and probably much earlier and continues throughout life. Fortunately most of our organs have a huge redundancy and so we can afford these declines without any level of illness. But at some point the decline may get to the point where we have a functional impairment that can be serious.

Hearing decline begins at about age 25 but is not noticed until much later.  Many will need reading glasses by age 40 even though having excellent vision for years; cataracts will occur later.  Balance, often not noticed until later, starts its inevitable decline early as well. Meanwhile internal organs including heart, lungs and kidneys are slowly declining and so too is brain function, especially cognition. 

This normal aging process of old parts wearing out is universal, is progressive, and is irreversible, at least as we know of it today. Let’s use bone mineral density (BMD) as an example. BMD is easily measured to demonstrate the sturdiness of our bones – how strong they are. We start out in life with cartilage rather than bones but as we grow as toddlers, then as children, then as teenagers, calcium and other minerals along with a protein-collagen matrix are laid down in our bones and they become increasingly strong reaching a peak at around the age of twenty. Once that age and that peak are reached it can’t go up any further – that’s it. Then there is a plateau and at about age forty it starts to decline at the one percent per year rate.   Since women tend to live longer than men, in total more women than men will have a fracture at some point in their lives. We might just say that is one of the risks of living longer.
At age twenty men’s bone mineral density is, on average, higher than women’s. Nevertheless for women as for men the decline is about one percent per year. Menopause changes this; the rate of loss increases to perhaps three percent per year for a few years and then returns again to the one percent average decline until reaching osteopenia and then osteoporosis. There are three important points to be made here. If we live long enough, our bone mineral density will decline to a level where if we fall a bone fracture becomes more likely. Since women start at a lower level and because they have this increased loss of BMD during menopause they’ll reach that fracture threshold in life earlier than men.

Cognitive function is another example; our brain loses some of its abilities as we age.   This loss of cognitive function over time should not be confused with the disease Alzheimer’s. Nearly everyone who lives long enough will suffer from some cognitive decline but only some will develop the disease known as Alzheimer’s. As with BMD, we reach our peak cognitive function around age twenty; it plateaus for about ten years and then starts the slow decline. Given the great redundancy in our brains, it is not noticeable for some time. [Figure modified from Science Magazine] Eventually we reach a functional threshold where our cognitive function begins to impair our ability. This becomes more apparent when an older person is engaged in highly technical activity, in very fast paced activities, or in stressful situations (emotional, physical or health related). Those challenges to cognition are less apparent when in highly familiar situations. 
Muscle mass and strength decline in a similar fashion resulting in sarcopenia. Most people lose perhaps 30% of their muscle mass between ages 50 and 70. [Figure modified from the Buck Institute] Individuals that exercise find it takes more effort to maintain their muscle mass and strength but regular exercise and good nutrition have a significant beneficial impact.

This loss of about 1% per year is normal. In the following post, I will look at some of the proposed mechanisms for the aging process and then turn to how to overcome them.

Thursday, September 20, 2018

Pre-Publication Endosrsements for "Longevity Decoded - The 7 Keys to Healthy Aging"

Longevity Decoded has been out since late Spring; here are the pre-publication endorsements that can be found on the back cover and on first inside pages.

Dr. Schimpff explores the exciting topic of healthy aging.   He combines the science of aging with evidence to suggest how each of us influences our personal journey in life.  We make choices everyday which impact our health.  This book will help you understand how those daily choices will influence your life not only today but as you get older.  Begin today to plan for tomorrow.   
James (Jim) M. Anders, Jr., CPA, MBA, CGMA, President and Chairman of the Board, National Senior Campuses, Inc., Administrator and Chief Operating Officer, Kennedy Krieger Institute, Inc.

A highly enjoyable and uplifting read written by a physician with uncommon intellect and wisdom.  Certainly, we can all benefit from following Dr. Schimpff's prescription for a healthier and more meaningful life.
R. Alan Butler, Chief Executive Office, Erickson Living

Brilliant work by Dr. Stephen Schimpff yet again!  Dr. Schimpff has done a systematic analysis of aging and longevity.   His uncanny ability to use data and science together makes his suggestions compelling and convincing, while being insightful.  Despite being a complete and thorough account for advanced readers, his book is simple enough to understand for a beginner. If there is only ONE book you want to read on this subject, it should be this…
Hiren Doshi, CEO, Paragon Private Health, Co-founder and President, OmniActive Health Technologies

The old adage goes “the only sure things are taxes and aging.”  Not so fast!  Reading Stephen Schimpff’s fascinating new book did not help me pay my taxes, and despite his sage advice, my birthday still came and went.  But the concepts he describes (in a meaningful and fun way) made me recognize that the age I feel is truly in my hands! -- 
Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University and Jefferson Health

We are witnessing the marketization of a backward behemoth – the U.S. Healthcare industry.  Consumers will become a force in a new health economy that will demand clarity, transparency, choice and value.  Seniors, already a major social and cultural force in our country, expect more from our healthcare system, and how we transform health for seniors will be central to how we develop the broader roadmap of market reform that is required to improve the health status of all Americans.  A big driver is the creation of incentives for healthcare consumers to engage in their healthiness.  Aging is not trivial, and it’s not a spectator sport, despite what the American medical complex has led us to believe.  Dr. Schimpff describes not only what we should expect as we age, but what is expected, and how our taking a more activist role in managing our health is a critical part of a maturing market. 
Don McDaniel, CEO, Canton & Company, Baltimore, Maryland 

With remarkable ease and with clarity of message, Dr. Schimpff demystifies the aging process and our current understanding. Most importantly he provides a simple, successful path to realizing your personal goals of health and well-being. As he remarks, You can do it.
Matt Narrett, MD, Chief Medical Officer, Erickson Living

As my age cohort heads toward Medicare, like a veritable tsunami of aging boomers, this text ought to be our navigational guide in the storm.  We will want yoga on the lawn, rather than a wheelchair in the garden, we will crave gourmet organic meals, not a nursing home tray!! Dr Schimpff will help us to achieve these dreams with his folksy and reassuring style. This book only confirms for me that the best is yet to come!
David B. Nash MD, MBA. Founding Dean of the Jefferson College of Population Health
In this easy to understand, yet frank and direct treatise intended for both patients and physicians, Dr. Stephen Schimpff successfully demystifies human longevity and its relationship to genetics and related environmental factors. He shows how the new primary care paradigm, variously known as direct primary care or concierge care or retainer-based care, allows for close relationships to form between physicians and their patients, which in turn facilitates the creation of customized and personalized health and wellness solutions to extend patient longevity. The ‘keys’ to a long healthy life revealed by Dr. Schimpff make it a must read for people young and old.
Guru Ramanathan Ph.D., Chief Innovation Officer, GNC

As the world's older population continues to expand at an unprecedented rate, Dr. Schimpff gives readers simple steps that can lay the crucial groundwork for our future health. He provides an optimistic approach to the inevitability of aging and a refreshing perspective that our 'golden years' can also be our 'golden age,' based on his first-hand experience as a healthcare practitioner.
E. Albert Reece, MD, PhD, MBA, Vice President for Medical Affairs, University of Maryland, John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine

We are living longer, but not necessarily better. Societal anti-aging biases are deeply held, reinforcing negative stereotypes about a time in life that should be defined by respect and opportunity. Longevity Decoded challenges this stereotype, offering an alternative perspective to aging that is not only positive but empowering. It is sorely needed in a society that is rapidly aging. 
Katie Smith Sloan, President and CEO, LeadingAge

Wednesday, September 19, 2018

Life Expectancy Has Lengthened But Not Equitably

For most of recorded human history, lifespans did not change. Then it doubled in about 100 years.

 At the time of Lincoln the average life span was 38 years; today it is about 78-80 years. But whenever it ends it is like a waterfall. Most people begin to die near to the expected point; the drop off in percentage still living declines precipitously. Fortunately, the waterfall has been pushed downstream by years and decades but eventually the time arrives.  
Like a slow moving river, we go through life in our 20s, 40s and even 60s with little concern or thought about death. Then almost suddenly we realize it is fast approaching. Can we as individuals push our personal waterfall further downstream? The answer is yes but to do so effectively requires starting back when we were not really thinking about it – as young adults or even better as children. 

Why have life spans increased? Many would credit better medical care and certainly that has had a significant role, especially for the individual person. But most of the effect comes from public health: decreased maternal mortality at childbirth, reduced infant mortality, reduced childhood infection mortality due to vaccines, and greatly reduced deaths due to infections such as typhoid fever and tuberculosis as a result of safe water and sewers along with pasteurization of milk. More people have better nutrition and better housing. As to medical care, antibiotics are the prime example of an improvement that had a major impact on early mortality as has care of those with trauma. In other words, deaths that used to occur in infants, children and young adults are largely curtailed today with most deaths now occurring in just the older age groups and usually due to chronic illnesses – illnesses that for a large measure are related to a lifetime of adverse lifestyles.

Longevity varies by location. Baltimore, Maryland is a good example. For a person born in 2011, it is estimated by the Centers for Disease Control (CDC) that the average life span will be about 72 years. But the variability based on location within Baltimore of that birth is striking. A person, likely white, born in an affluent neighborhood will live on average to 83 years. A child, likely black, born in a socially economically distressed area will die on average by age 63. Longevity varies by sex, race, location and many other factors but in the end it is only partly due to genetics, somewhat due to environment and very much due to how we treat our bodies over time. Of course, a person in a poor neighborhood has less access to good food, finds it unsafe to let the kids out to play, is chronically stressed just dealing with the bare necessities of life and is barraged with advertisements for tobacco and alcohol while drug dealers abound on the corners and violent trauma is commonplace. So it is not necessarily chosen behaviors but a lifestyle of necessity that determines variations in longevity.

Praise for Dr Schimpff

The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.

-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).