“No one wants to live an extremely long life when they are in very poor health and have a lot of chronic disease….By delaying the onset of diseases and cognitive and physical functioning problems…people can still be engaged in society… I think that is the ideal we should be striving for.”
1. How long can we live a healthy life?
“Our concept of aging has changed. Instead of worrying about how long we will live—our life span—we now understand that how long we can live a healthy life may be more important. This is the concept of “health span.””
“And although we’re living longer, we’re living longer with one or more chronic illnesses. That’s the paradox in all of this. You just look at the headline figure of life expectancy, and you think, wow, what an astonishing achievement we have made. But you look underneath that and you see that actually we’ve created a population that is dealing with multiple physical and mental health problems. It’s a consequence of the gain in life expectancy. These extra years of life are sometimes not healthy.”
2. Living longer isn’t the same as living better
- 1/5 people now live to 100 years old
- Caroline Abrahams, charity director at Age UK, said: “It is an incredible testament to the advances in medicine and the increasing effectiveness of preventative treatments that nearly one in five people are now living to see their 100th birthday.
- Are we living better?
- “However, with an ageing population, there is only cause to celebrate if we can ensure that older people are still able to live fulfilling lives.”
- From 1990 to 2017, life expectancy at birth increased by 7·4 years from 65·6 years in 1990 to 73·0 years in 2017.
- The greatest increase was in lower socio-economic status countries
- The increase in years lived varied from 5·1 years in high SDI countries to 12·0 years in low SDI countries.
- Of the additional years of life expected at birth, 26·3% were spent in poor health in high SDI countries compared with 11·7% in low-middle SDI countries.
- “With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages”
- ‘Global life expectancy has increased considerably in the last decades, for both men and women. In the Netherlands, life expectancy is estimated to further increase from 73.1 and 82.8 years in 2012 to 85.7 and 88.5 years in 2050 for men and women, respectively.”
- “Nevertheless, people who live longer are not necessarily in good health.”
- “Essentially, everyone has two ages: a chronological age, how old the calendar says you are, and a phenotypic or biological age, basically the age at which your body functions as it compares to average fitness or health levels.”
- “Chronological age isn’t how old we really are. It’s a superficial number,” said professor David Sinclair, co-director of the Paul F. Glenn Center for the Biology of Aging at Harvard Medical School.
- “We all age biologically at different rates according to our genes, what we eat, how much we exercise and what environmental toxins we are exposed to. Biological age is what determines our health and ultimately our lifespan. Biological age is number of candles we really should be blowing out.”
- “Levine and her team identified nine biomarkers taken in a simple blood test that seemed to be the most influential on lifespan. The biomarkers include blood sugar, kidney and liver measures, and immune and inflammatory measures.”
- “People with a biological age lower than their chronological age have a lower mortality risk, while those aging older from a biological standpoint have a higher mortality risk and are potentially more prone to developing the diseases associated with the higher age range.”
- “But perhaps what’s most important here — unlike results from genetic testing — is that these are measures that can be changed. Doctors can take this information and empower patients to make changes to lifestyle, diet, exercise and sleep habits, and hopefully take steps to lower the risk and improve their biological age.”
- We actually know a lot about how to change some of these markers. I think we are given the information much earlier in the process, hopefully before someone ever develops disease, and then they can really take steps to improve their health before its too late.”
- Levine is working with a group to provide access to the algorithm online so that anyone can calculate their biological age, identify potential risks and take the steps to help their own health in the long run.
- “No one wants to live an extremely long life when they are in very poor health and have a lot of chronic disease,” Levine said. By delaying the onset of diseases and cognitive and physical functioning problems, “people can still be engaged in society,” she said. “I think that is the ideal we should be striving for.”
3. Disability is rising
- Our focus has shifted from communicable to non-communicable causes of disease (NCDs) burden and injuries
- Even in the most wealthy countries the time lived in full health constitutes only a small fraction (17·5%) of the overall life course.
- “Large, impressive, and sustained gains are being made against the majority of leading causes of death in most countries…. these gains are not being accompanied by commensurate declines in age-standardised rates of disability”
- Disability compromises health span. Most disability is due to –
- musculoskeletal disorders
- mental and substance use disorders
- neurological disorders
- & diabetes
- “The problem for the rich countries is that although they’re doing well in some areas like maternal and child health, the fact is if you take chronic diseases and the risk factors for those diseases, particularly obesity and diabetes, there’s no country in the world that’s been able to successfully tackle all of them. The four big issues for me are blood pressure, tobacco, diabetes and obesity”
- “For the first time this year, the Global Burden of Disease separates the disability data for men and women. And it’s a shocking story for women. Women have a huge burden of life lived with disease, much more than men.”
- ‘considerably more women than men suffer from conditions like that can disable them, anything from mental disorders to back pain”
- ‘There are things that sometimes we don’t take very seriously, such as musculoskeletal disorders by which I mean things like arthritis and back pain. It seems trivial compared with a heart attack, but they stop you from doing your job, from interacting with your family, they confine you to your home or bed.”
4. Even life span has stopped expanding
- declines in mortality rates are now plateauing
- “in many countries they’re stagnant because of an epidemic of chronic diseases”.
- “Obesity is now leading to a million deaths every year from type 2 diabetes, which is truly alarming.’
“Between 2010 to 2012 and 2014 to 2016, the rate of increase in life expectancy at birth more than halved to 6.0 weeks per year for males and 3.6 weeks per year for females.
“Part of the reason for this could be that some of the factors that have historically driven life expectancy improvements, such as reductions in smoking and circulatory disease, may largely have been realised.”
5. Disability: How do we define it
Disability-Adjusted Life Year (DALY)
Quantifying the Burden of Disease from mortality and morbidity
One DALY can be thought of as one lost year of “healthy” life. The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.
DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences:
Promoting wellbeing requires we can measure DALY.
The largest contribution to global DALYs was from NCDs
NCDs – 62·0%
Communicable diseases – 27·9%
Injuries – 10·1%.
Women live longer than men, but also have “more years lived in poor health”
“Women are more likely than men to have a higher burden from disabling conditions (eg, most musculoskeletal disorders…whereas men are more likely than women to be affected by fatal conditions including different types of cancer (eg, liver cancer, lung cancer, leukaemia, colorectal cancer, and pancreatic cancer), injuries, and ischaemic heart disease”
“Our results showed that the additional years of life were accompanied by poor health to some extent….and the burden from musculoskeletal disorders and mental disorders has not improved over time”
6. What can be done to increase life span?
- 12-14 years of additional life span (in a 50 year old) can result from healthy lifestyles
- 5 low-risk lifestyle factors are
- never smoking,
- body mass index of 18.5 to 24.9 kg/m2
- ≥30 min/d of moderate to vigorous physical activity
- moderate alcohol intake
- and a high diet quality score (upper 40%)
7. What can be done to increase health span?
- What are the potentially modifiable factors that are “related to living longer in good health”?
- Unhealthy behaviours include being
- physically inactive
- People who combine more health behaviours have a reduced risk of major chronic diseases including myocardial infarction, stroke, diabetes mellitus, and cancer.
- physically active
- normal body weight
- eat healthily
- “Our study results show that persons with a healthy lifestyle live longer in good health.”
- The disease burden among persons who
- never smoked,
- maintain a normal BMI,
- are not physically inactive,
- and adhere to a healthy diet
- is considerably lower than that of those who do not adhere to any of the healthy lifestyle behaviours and results in a minimum of 2 years longer life in good health”
- those with the healthiest lifestyle
- healthy weight
- healthy diet
- getting regular exercise
- not only lived longer, but had fewer disabled years at the end of their lives.
- Can expect to live 4.8 years longer than his counterpart in the unhealthiest group,
- & and at the end of life, spend only two of those years disabled, compared to 3.7 years for the unhealthy counterpart.