Changing Age – Changing Expectations of Life

Tom KirkwoodInstitute for Ageing and HealthNewcastle University

The Continuing Increase in Life Expectancy

UN estimate 1980

UN estimate 1990

UN estimate 2000

Oeppen & Vaupel Science 2002

Declining early/mid-life mortality Declining later-life mortality

The Traditional View of Ageing

The ageing process is biologically determined (we are programmed to die) with an inbuilt limit to lifespan

The ageing process is one of progressive, irreversible loss of functional capacity and of quality of life

Ageing is something that only concerns people in the later years of life

Increasing human longevity threatens to impose an intolerable burden on societies around the world

What happened? Why??

The “Disposable Soma”

Ageing – Historically a Rarity, Now Routine

1900

2000

20 8040 60 Age

Implications of the Disposable Soma

We are not programmed to die.

We are programmed for survival but in our ancestral environment investments in reproduction were a higher priority than long-term survival.

Ageing is caused by the build-up of faults.

Ageing and Development

Senescent Cell (human fibroblast)

●DNA damage foci●Telomeres●Overlap of damage foci with telomeres●Mitochondria with high membrane potential (good)●Mitochondria with low membrane potential (bad)

BBSRC/EPSRC Centre for Integrated Systems Biology of Ageing and Nutrition

Centre for Integrated Systems Biology of Ageing and Nutrition

Disease A

Disease B

Disease C

‘Upstream’ ‘Downstream’

Multi-Stage Progression of Age-Related Disease

Dementia and Neurodegenerative Diseases1960s

First survey of prevalence in the community (Kay)First psychometric test for diagnosing dementia (Hopkins)

Alzheimer’s disease recognised as the most common cause of dementia in older people (Blessed,Tomlinson,

Roth)

1970sCholinergic deficit in AD discovered leading to development of first symptomatic treatments (Perry E)

1990sDiscovery of dementia with Lewy bodies (DLB) as the second most common cause of dementia in older people (Perry R, McKeith)

Establishment of Newcastle Brain Tissue Resource with MRC support

2000s Vascular cognitive impairment characterised as a major determinant of dementia in old age (Kalaria, O’Brien)

Work starts to determine the causes of dementia in Parkinson’s disease (Burn)

Demonstration of links between mitochondrial mutations and neurodegeneration and establishment of RCUK Centre for Brain Ageing and Vitality (Turnbull)

Establishment (with UCL) of national Clinical Research Network on Dementia and Neurodegenerative Diseases (McKeith)

Centre for Brain Ageing and Vitality

• Stem cell ageing• Sarcopenia• Nutritional effects on DNA repair and DNA

methylation• Vascular ageing• Protein metabolism• Mitochondria• Exercise

– Muscle Assessment and Training Laboratory (MRC Translational Funding £760k)

Working with the NHS

Our partnership with the NHS is essential: The NHS as a research environment. Partnership in NIHR Biomedical Research Centre on

Ageing and Age-related Diseases. Business opportunities in partnership with the Newcastle

upon Tyne Hospitals NHS Foundation Trust.

Other NHS links: Strategic Health Authority. Primary Care Trusts. Mental Health Trust. Other regional NHS Trusts.

What Accounts for the Individuality of Human

Ageing?

Factors Influencing Health Trajectories in Old Age

Genes Nutrition Lifestyle Environment Socioeconomic status Attitude

These factors and their interactions are being studied in the Newcastle 85+ Study; a 5-year prospective study in more than 1000 individuals born in 1921 of the biological, clinical and psychosocial factors associated with healthy ageing.

The LIVEWELL Programme

Objectives:

•To develop and pilot an integrated suite of pragmatic interventions to promote health and well-being in later life

• To define a panel of outcome measures, including biomarkers of the healthy ageing phenotype

• Use retirement as the “window of opportunity” for interventions

Academic ‘quarter’Wolfson Research Centre (1999)Wellcome Biogerontology Building (2003)Newcastle MR Centre (2005)Edwardson Building (2008)Clinical Ageing Research Unit (2008)Translational Research Building (2010)

Clinical ‘quarter’Centre for Health of the Elderly (NHS)Old Age PsychiatryNIHR Biomedical Research Centre on AgeingRehabilitation/Primary Care

Business and Engagement ‘quarter’Teaching and Engagement CentreResearch and Innovation Care FacilityCentre for Assistive TechnologyFood Research CentreIndustry Buildings

Retail ‘quarter’Retail outlet(s) attracting cross-section of publicFlagship store with pioneering facilities/services

The Campus for Ageing and Vitality

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BBC Reith Lectures 2001

House of Lords Select Committee on Science and Technology, 2005

EU AgeAction: ‘Changing Expectations of Life’, 2007 (http://ageaction.ncl.ac.uk)

Foresight Project on Mental Capital and Wellbeing, 2008

Developing the Agenda

Foresight Challenge Project: Mental Capital Through Life

The Traditional View of Ageing

The ageing process is biologically determined (we are programmed to die) with an inbuilt limit to lifespan

The ageing process is one of progressive, irreversible loss of functional capacity and of quality of life

Ageing is something that only concerns people in the later years of life

Increasing human longevity threatens to impose an intolerable burden on societies around the world

We are programmed for survival not death.

Increasing longevity is a resounding success bringing major opportunities as well as challenges.

Youth and age are a continuum

Ageing is intrinsically malleable

A New View of Age

•Within the US, the economic benefit of the increase in life span since 1970 is estimated to have been worth $73,000,000,000,000.

Barriers to Changing the Status Quo

Fatalism – “I can’t change it anyway”. Negative stereotyping – “Old people are

losers”. Tunnel vision – “This is how it has to be” Youth bias – “We must invest in the future!” Restrictive accounting of costs and benefits –

“Why should I pay when it’s not me that benefits?”

Lack of hard evidence – “I won’t consider it until it’s proved to work”

Short-term’ism – “I’ll deal with it when I’ve fixed the immediate crisis”.

Changing Age- Waking up to the 29-hour day!

• Each day we have 24 hours for now, and 5 hours for later.

• How good will those 5 hours be when we come to use them?

• Can we make them better?

Research – Training – Engagement