We know that we are living longer and healthier lives – we hear it all the time. Still, sometimes it seems as though old age catches up to all of us in the end. In that regard it’s been a slightly depressing week for Canadians. Regardless of your politics you might have heard that the ageing process has not been kind to two of our political icons: Ralph Klein and Dan Heap.
Our hearts certainly go out to Mr. Heap, the former Spadina MP and social justice crusader who is now languishing away on awaiting Long-Term Care placement. It seems strange to hear that a young Ralph (dubbed “King”) Klein is suffering from frontotemporal dementia and headed to a Long Term Care facility. Vulnerability is not an adjective that would have ever come to mind when describing the boisterous and outspoken former Alberta Premier. Events such as these can only remind us that we must all eventually pay the piper. But does getting older necessarily entail that we become fragile ? Do we all inevitably end up in Long Term Care?
Today, age is no longer synonymous with infirmity. In this two part series, we will first examine the changing face of ageing and ask whether a positive outlook is actually tied to better outcomes. Subsequently, we will investigate what happens in case we do become incapacitated.
An Unprecedented Era in Human Evolution
And now for some good news: it’s an incredible time to be part of human history. According to health and longevity researcher Robert W. Fogel of the University of Chicago, over the past 100 years “humans in the industrialized world have undergone a form of evolution that is unique among the 7, 000 or so generations of humans who have inhabited the earth.” In other words, we are much bigger, more robust and stronger than our ancestors. This has important implications for how we view and think of ageing in the future.
Heart and lung diseases as well as arthritis are occurring 10 to 25 years later than they used to and there is less disability among older people today. You may, as I did, wonder how researchers are able to determine all of this. The desire to understand the causes of good health and longevity obviously drives many scientists. Although there is no one right answer, some leading theories have emerged. They paint a fascinating picture. Some of these findings may surprise you!
It is a commonly held belief that we keep people alive with the help of modern medicines but that the quality of life has not really improved. In order to draw conclusions about changing health – researchers need good samples of valid data. Dr. Fogel and his colleagues found an ideal opportunity to study the problem: they analyzed a sample of 50, 000 Union Army Veterans – the first generation to turn 65 during the 20th century. They compared the vets’ health data found with the health outcomes experienced by seniors today. They found that people at the turn of the century were not just sicker but that they were sicker much longer than they are today. According to Fogel, 65% of American men 18-25 signed up to serve in the Union Army during the Civil War.
Obviously there are always outliers: people who lived longer healthy lives then and people today who become gravely ill early on in life now. On the whole, however, improvements in health and longevity have been measured in all of the industrialized populations where these studies have been performed. In 1900, 12% of people who were 65 could expect live to be 85 compared with nearly 50% today. It used to be that 80% of American men had heart disease by the time they were 60 compared with less than 50% today. These changes have also been accompanied by significant changes in our physiology – American men are now 3 inches taller and 50 pounds heavier than they were 100 years ago.
The Barker Hypothesis
While genes and modern medicine partially explain away some of the differences that cause some populations to be healthier than others they don’t account for everything. One of the surprising leading hypotheses has to do with events that take place in the womb and in the early stages of life but whose effect does not show up until middle and old age. In the academic community it is known as the “Barker hypothesis” after David J.P. Barker, a professor of medicine at Oregon Health and Science University in Portland.
He believes that what happens to us before age 2 has a permanent and lasting effect on our health. He examined the records of several populations that would have undergone hardships – people whose mothers may have been starving or may have been pregnant in adverse conditions. People in Helsinki between 1933 and 1944, for example. He found that those whose birth weight was mostly less than 6.5 lbs and who had a low BMI, as infants were more likely to suffer from heart disease earlier on in life.
The same was found while studying a population of children born to women pregnant throughout the Dutch famine that took place during World War II. Dr. Theresa Roseboom found that the children who survived birth seemed fine until late middle age where they started suffering from chronic diseases at much higher rates than normal (they were three times more likely to get heart disease as people born after the famine and also suffered from more diabetes and kidney disease).
Even those who were initially skeptical have come around. Dr. Douglas V. Almond of Columbia University originally objected to the Barker hypothesis on the basis that the studies had not examined randomly selected populations. He felt that this made if difficult to establish causality as a variety of other factors could have been at play. In order to test the hypothesis, he decided to study an event that had affected everyone: the 1918 influenza pandemic. He compared those whose mothers were pregnant during the epidemic with those whose mothers were pregnant shortly before and after. He found that the children born to mothers pregnant during the flu epidemic had more illness, especially diabetes (in this population the incidence was 20% higher by age 61).
Of Cardiovascular Disease and Frailty
Tamara Harris, Chief of Geriatric Epidemiology at the National Institute on Ageing says that the reason some people may age well and others don’t may have to do with frailty involving “exhaustion, weakness, weight loss, loss of muscle mass and strength. A prognosis whose causes were little understood”. Frailty is one of the reasons people may loose function and independence while getting older. Scientists are increasingly finding that undetected cardiovascular disease is the reason people become frail.
There are many misconceptions about cardiovascular disease: people imagine that it mostly affects men and that symptoms are limited to chest pains and stroke. In fact, cardiovascular disease is not only the leading killer of women; it is also the leading cause of disability. The disease may partiallyobstruct blood vessels in the brain, legs, kidneys and heart resulting in exhaustion, mental confusion and weakness. Once people stop using their muscles for walking, standing etc., they atrophy leading to further frailty.
The Future Looks Different
These are but two of the leading scientific theories that explain why people are living healthier longer lives and why we know that this trend will only increase as the boomers age. Today’s boomers will be the first generation to grow up having had childhood vaccines and antibiotics. Their early lives were better than their parents’.
Investigators also hope that new insights into the role played by cardiovascular disease in late-life disability will enable them to slow, delay or prevent these changes by treating the disease instead of the symptoms.
In 1957, the life expectancy of a 65-year-old Canadian was 14.6 years. By 2007, it had risen to 20.0 years. And those extra years are healthier too. Will old age be the same for boomers? No, it will not. And as we will see, this is something to be celebrated.