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.

Some Thoughts on Aging – Denial versus Acceptance versus Rejoicing

Those of you who have read some of my past articles are aware that I wrote mostly about various aspects of primary care and our dysfunctional healthcare delivery system overall. A few years ago I wrote a post for KevinMD on moving to a retirement community. Since then I became interested in the actual process of aging and did some further posts for KevinMD. Why do we age? Why do our various organs lose function over time when does it start and how fast does it occur? Can we do anything about it; can we slow it down? Why do complex chronic illnesses become more prevalent with aging? Can we prevent those? What research is ongoing? And from there - would a pill delay aging? What are the efforts to actually reverse aging, a search for the Fountain of Youth? After a few years of research came “Longevity Decoded – The 7 Keys To Healthy Aging” which was published in April, 2018 and is available on Amazon. This article and those to follow are based on this journey of exploration.           Your comments will be most welcome.

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We are all aging every day but mostly we ignore it, do not recognize it or deny it. Then all of a sudden we look in the mirror and realize that older age has found us. Even then each person deals with aging differently. 

There is a parody by an unknown author of Dr Seuss’ “The Cat in the Hat” which takes a negative perspective on aging. Perhaps “The Cat in the Hat” says much of what many people feel and think.

But there are other perspectives, many much more positive.

After I told a friend about the concept of what I was writing, he sent me the following: “About 25 years ago I received a video about the Adirondack Park. When the park was established - in the late 1800's I believe - the New York state government drew a blue line around the immense region. Individuals living inside the park were allowed to stay, and pass their land onto heirs, but they could not sell their property to others. Over the succeeding generations the land not passed on to heirs became owned by the state. The video was about a gentleman in his 60's who was one of the last of his generation and focused on preserving what had been the Adirondack way of life - realizing it was about to fade into history. In the video as he talked he slowly unfolded a 6' wooden ruler. He went on to indicate that the 72 inches represented the average lifespan in years for many folks. He then indicated his age on the ruler and made the point that while he hoped to live beyond the end of the ruler he realized his time was short and he had limited time to accomplish his goals.

“My dad had recently passed away - at the age of 72 - and in his tools I found a folding ruler. After seeing the video I picked up the ruler and unfolding it became aware I was beyond the half way point. Over the years I have often opened and looked at the ruler. I recall at 50 feeling that time was speeding up. For some reason now that I'm in my 60's the passage of time bothers me less - but I am aware of the limited amount left. I am also focusing more on what happens when, hopefully, I go beyond the end of the ruler.

“It seemed to me your audience may benefit from an increased awareness of time and what they can do to productively live their lives now with that goal of having an enjoyable existence in the future.”

Good advice. Here are some other bits of personal philosophy about aging and its impact on us as individuals.

Ian Brown in his book The Experiment rebels at aging through his diary that he starts at age sixty. As recounted by Gerard Helferich in a Wall Street Journal book review, “His journal is largely a protest against decline. His hearing is fading, along with his memory. His knees ache. His arches have fallen. His face sags, and a patch of hair over his forehead resembles ‘a random stand of corn that somehow got planted away from the main field.’ He has rosacea, age spots and a hemorrhoid. Though he and his friends still hike and ski, it’s a case of ‘ever-older men doing daring things, to prove we’re still daring, and therefore not older.’ Mostly Ian Brown regrets not taking more risks… he is afraid that he hasn’t lived up to his promise… A friend reminds him that we spend the first half of our lives wishing we looked like someone else and the second half wishing we looked like our former selves.”

Willard Spiegelman, on the other hand, in his early 70’s when he wrote Senior Moments may be, says  Helferich, “closer to the end than Mr. Brown, [but] he doesn’t betray dread or regret but a gentle, teasing acceptance. ‘We come into the world alone, with a cry…we exit alone, to confront the final eternal silence. The fun, all the pleasure and adventure, lies in between.’ [The two books] striking dissimilarities—in content and form but especially in attitude and voice—derive from the authors’ varying views on life more than from their relative ages or their divergent attitudes about the end of life. Whether we are 60 or 70, or 80 or 90, how fiercely we rage against the coming of that good night depends above all on how we have embraced the sum of our days.”

“The Cat in the Hat” has a clearly negative perspective on advanced years and certainly not all would agree. My friend with the 72-inch ruler is rather philosophical while recognizing that time is indeed moving on.  Brown wants to deny and so does “daring” adventures while Spiegelman is more accepting of what lies ahead. 

The perspective of an older person is related mostly to how he or she perceives life and how he or she has lived their earlier years. It is with that background of life and living that we come to terms – or not - with growing older.

More is in   Longevity Decoded – The 7 Keys to Healthy Aging

 

Yale Medicine Review of Longevity Decoded

We all age. As the years go by, we get grayer, develop new wrinkles, and feel less spry than we once did. It is just part of life, right?Well, what if there was a way to dramatically slow down the aging process? According to Stephen Schimpff, MD, MACP, there is. In his new book, Longevity Decoded: The Seven Keys to Healthy Aging, Schimpff identifies the seven "keys" to living longer and healthier lives.

Before you roll your eyes, you should know that this isn't some New Age, woo-woo mumbo-jumbo. Schimpff's longevity "keys" are both practical and deeply rooted in science.

In fact, you've probably heard most of them before: Eat a healthy diet, exercise, get enough sleep, avoid tobacco, manage stress,stimulate your brain, and engage socially. These so-called "keys"aren't necessarily new or groundbreaking, Schimpff concedes, and many are intuitive. Taken together, though, they can have a real and measurable effect on your life.

"We're always told to start saving for retirement when we're young because it will compound and our investment will grow," he says. "What I wrote about is the same message: If you start early, the benefits will compound over time."

Longevity is more than just a list of what you should and should not eat or do as you get older. It's an accessible and entertaining overview of the latest research on aging, detailing what scientists currently know about the process at a cellular level and what they're studying in laboratories around the world.

Is aging caused by free radicals? The structure of our DNA?The health of our gut microbiome? Turns out that while there's compelling evidence about each of these things, the science just isn't there yet.

"There are a lot of ideas about why we age; yet, when you get right down to it, we really don't know. We don't know what turns it on,and we don't know what turns it off," Schimpff says. "For all of our biomedical research since WWII, not that much has been spent studying the aging process."

As more and more people live beyond 65 years of age--an estimated 19 percent of the world's population will be older than 65 by2030--that is changing. What's more, as research increasingly shows that our bodies begin to decline as early as 30-years-old, concerns about aging are no longer just relegated to the elderly.

"Everybody knows that we should eat better, exercise, soon, but most people don't know why," Schimpff says, adding that people often think superficially and in the short-term when it comes to health.

"We need to get away from that and talk about our health and keeping healthy for the long-term. And if there's a message in this book,it's that we have it within our power to make a very significant change in our life... can we prevent every disease? Absolutely not. But as individuals, we can have a huge impact."

Condensed from a review by Miriam Wasser in Yale Medicine, April, 2018 

 

Longevity Decoded Press Release

FOR IMMEDIATE RELEASE                                                      

Contact:           Stephen C. Schimpff, M.D.                           

                        Schimpff1@gmail.com                                 

                        410-960-9829            

 New Book Reveals Seven Proven Actions to Slow Aging and Chronic Illnesses

Leading physician and healthcare expert shares how aging can be slowed

BALTIMORE, Md., April 26, 2018—A new book by a nationally recognized physician leader and healthcare policy expert reveals seven ways you can slow the aging process and prevent many chronic illnesses. In Longevity Decoded – the Seven Keys to Healthy Aging, Stephen C. Schimpff, MD, former Chief Executive Officer of the University of Maryland Medical Center, reveals how much our daily choices influence the aging process.

“To the surprise of many, our bodies slowly decline starting in our 30s and 40s, with each organ and tissue losing about 1% per year. Most of us don’t notice the decline until it’s too late – after we fall and break a bone, or forget where the car is parked,” says Dr. Schimpff.  “But we have the power to change that if we modify our lifestyle. The critical question is, ‘Will each of us accept and follow the advice on eating, moving, managing stress, sleeping, not smoking, and being intellectually challenged and socially engaged?’” 

Unfortunately, the American healthcare delivery system focuses on disease, not wellness. The good news is however old you are, paying attention to these seven actions will slow the aging process, reduce chronic diseases, and result in a longer life with better health.

E. Albert Reece, MD, Dean of the University of Maryland School of Medicine, says of the book, “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 a refreshing perspective that our 'golden years' can also be our 'golden age,' based on his first-hand experience as a physician.”

In his fifth decade as a physician, educator, cancer and infectious disease researcher, academic medical center executive and author, Dr. Schimpff is one of the world's foremost experts on healthcare. A professor of medicine and former professor of public policy at the University of Maryland, he is also a senior advisor to  Sage Growth Partners and Sanovas, Inc. and is internationally recognized for his cancer and infectious disease research at the National Cancer Institute's Baltimore Cancer Research Center and the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center. Board certified in internal medicine, infectious diseases, and medical oncology, and recently inducted as a Master in the American College of Physicians, he has published more than 200 scientific articles, reviews, and editorials, and has edited major textbooks on cancer, infectious diseases, and healthcare. This is his sixth book for a general audience.

Dr. Schimpff is a graduate of Rutgers University where he was a Henry Rutgers Scholar. He obtained his medical degree from Yale Medical School, where he was inducted into the Alpha Omega Alpha national honor medical society. 

Other Reviews

“In this easy-to-understand, yet frank and direct treatise intended for both patients and physicians, Dr. Schimpff successfully demystifies human longevity and its relationship to genetics and related environmental factors… The ‘keys’ to a long healthy life revealed by Dr. Schimpff make it a must-read for people young and old.” – Guru Ramanathan PhD, Chief Innovation Officer, GNC

“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 Anders, Jr, CPA, Chairman of the Board, National Senior Campuses, 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, CEO, Erickson Living, and board member, University of Maryland Medical System

For more information or to purchase “Longevity Decoded – the Seven Keys to Healthy Aging”, visit Amazon