Are you old?

Ask anyone and they will tell you that they don’t think they are as old as they are. And yet, you might also hear the same person complain about “feeling old” when asked to complete some physical task like walking up stairs. This sums up a major problem with research into ageing – what is old and how old are you really? 

We have been taking part in a longevity revolution. But we are not only living longer, our concept of when we transition from middle age has also changed. In the 1920s we were thought to be old from age 44 whereas it is now thought to be around 60 for men and 65 for women. According to many observers we are standing on the precipice of yet another revolution in lifespan modification. In this brief series we mark the completion of the clinical phase of the MID-Frail study, a major new international research study examining the effectiveness of combining optimised medical management with exercise and dietary programmes to maintain function and quality of life in people aged over 70 years who have Type 2 diabetes, and the first phase of the Frailomic initiative, a large scale research project aiming to identify the factors that turn frailty into disability, by taking a snapshot of current developments in the science of ageing. These large research projects being run by Niche Science & Technology Ltd. are funded by multimillion Euro grants from the European FP7 Framework and reflect the concern governments have over the impact that population ageing will have in the next decade.

It is universally agreed that access to sanitation, waste removal, electricity, refrigerators, vaccinations and our constant improvements in healthcare are responsible for increases in our life expectancy. But it is also pushing more and more people into the group defined as ‘elderly’. In some, this is not a concern, the media is filled with stories of 70-year olds running marathons and completing triathlons. But these people are generally anomalies whereas most people will eventually become frail. Frailty brings exhaustion, weakness, weight loss and a loss of muscle mass and loss of strength. In addition, the risk of concomitant diseases such as diabetes, dementia and cardiovascular disease increases markedly as we enter our 50s, 60s and 70s.

Ageing brings a grim prognosis. When coupled with increases in life expectancy it means that many can expect to spend extended periods experiencing distressing loss of functionality, making it the most problematic expression of population ageing. And there are tremendous associated costs of care. Governments are responding to concerns over the cost of ageing by limiting access to retirement schemes. Designed to provide relief to the elderly and introduced at the end of the 19th century, pensions have failed to respond to the changing demography reflected in our ageing population with schemes becoming financially unsustainable. Who will pay for 30-year retirements if frail 70 year olds can’t continue in employment and how will society pay for the care of the burgeoning numbers of frail? In its search for immortality society faces significant challenges in adjusting to the greater number of people living longer.

For you, as an individual, it seems that the most poignant question is not ‘How old are you?’ but more likely ‘Are you going to become frail?’ Landmark studies have developed valid models for frailty and these have allowed epidemiological studies to demonstrate the association of frailty with quality of life and adverse health outcomes. New research is needed to discover more efficient methods to detect and severity grade frailty as part of routine clinical practice, particularly methods that can be used in the primary care setting. This would greatly inform the appropriate selection of older people for invasive procedures or medications and could be the basis for a paradigm shift in the care of frail older people towards a more appropriate goal-directed care. Our Frailomic initiative is looking at the possibility of predicting frailty through identification of predictive biomarkers. Currently, you can only assume your health status in your retirement years based on population data. For example, the Cardiovascular Health Study, a US study of more than 5,000 participants 65 and older, found that 9.5% of those 75–79 years of age were frail. Among those aged 80–84 years, about 16% were frail, and nearly a quarter of those 85–89 had overt frailty. Clearly, as the study was conducted in the USA these figures reflect data from a wealthy Western society whereas countries with fewer resources are likely to fare less well (though we shouldn't discard the observation that many of the unpleasant consequences of ageing reflect the excessive practices associated with the Western lifestyle). Will we ever be able get an idea how best we can prepare for a healthy old age? When will it start? How long will it last? What treatments will provide improvements in longevity and who will be able to afford them?

It seems reasonable to assume that although you can consider yourself to have entered old age at around 60 years, you won't know whether you have (on average) 10 to 15 years of ‘useful contribution to’ or whether you may be a ‘burden on’ society. On the bright side, up until now our media have been fixated on youth. It begs the question how much this might change as the working population ages and all the programs on all the channels are made by elderly actors, speaking lines by aged writers and filmed by myopic cameramen. Joking apart, the socioeconomic consequences are unfathomable.