Age Action One-Day Conference: 23 April 2007

Please
note that these are just notes, and not a formal write-up of the
conference proceedings. Therefore there may be personal bias, and
there most definitely is personal opinion, and there are also most
definitely grammatical errors. For the latter, you have my apologies,
as there is only so much time I can devote to proofreading these
notes. I have tried to make all my notes clear, but please remember
they were taken “in the heat of the moment”.

Further,
though they are notes of what speakers, panelists, and delegates
said, there may be errors on my part. If you need clarification of
any item, it is best if you email the speakers directly. I hope you
find these notes useful! It was a very interesting day of talks and
discussions on current challenges in ageing research and social
acceptance of both the research and the demographic group itself.
Large sections of these notes are from panel discussions, where I
tried to capture the Q&A sections to the best of my ability.
However, I may have misheard either the Q's or the A's, and you
should also be aware that these are the areas where I inserted the
majority of my opinions!

Also,
those bits of the talks or discussions I found most interesting are
highlighted in red.

Notes,
AgeAction 23 April 2007

The
Sage, Gateshead

Run
by the Institute for Ageing and Health, Newcastle University

Tom
Kirkwood
, Centre for Integrative Systems Biology of Ageing and
Nutrition, Newcastle University

Life
expectancy has increased steadily over the past 200 years. 1980
prediction of life expectancy was wrong (too low). This was due to
the belief that lifespan is fixed. Instead, the increase in life
expectancy is showing no sign of slowing. Initially, increase in
lifespan chiefly due to improvements in sanitation, medicine etc
reducing infectious diseases. Now, the increase in lifespan being
driven in declines in later-life mortality. We should “reexamine”
the belief that there is something set in stone about the life
expectancy and the max lifespan.

The
29-hour day is a illustrative example of the rate at which our
lifespans are increasing. Each day we have 24 hours for now, and 5
hours for later. How good will these 5 hours be? Can we make them
better?

Why
does ageing occur? Because life expectancy was truncated due to
hazards in the environment, it wasn't genetically viable to “build”
bodies that would last a long time. Ageing process is driven by
things that go wrong in the body. Over time, cells pick up a host of
subtle faults (errors in duplication, free radicals, ROSs (Reactive
oxygen species) – oxygen is a “dangerous” element. Random
molecular damage leads to an accumulation of cellular defects. Over
time, the number of cells with these defects increases to the point
when the person develops age-related frailty, disability and disease.
Damage starts even before we are born. Is there a limit (currently
122 years 5 months set last year) to our longevity?

Does
increasing longevity mean an inevitable population explosion? It
seems not, as as the average age of a population increases, the birth
rate seems to drop. Do longer lives mean more diseases? For many imp
diseases, age is the largest single “risk factor”, and
understanding why aged cells and organs are more vulnerable to
pathology will open new paths to prevention and cure. We have many
medical institutes but very few of these include research on ageing.

Can
we afford increasing lifespans? Increasing medical costs driven by
medicine becoming intrinsically more expensive. Investing in
prevention is cost-saving, and care costs can be improved by changing
the way we deal with ageing (socially). In the US, the estimated
economic benefits of increasing lifespan worth 73 trillion $. Will a
greater focus on ageing harm the interests of the young? As most
young people will reach old age, addressing the challenges of
population ageing benefits all. If the older people are healthier and
lead less dependent lives, reduces the burden on the younger people.

Factors
influencing longevity and health span include genes, nutrition,
lifestyle, environment, socioeconomic status, and attitude. Human
ageing is malleable and longevity may be increased by decreasing
exposure to damage. Within Europe, Tom feels we urgently need to
build critical mass in terms of increasing research into ageing – a
European network. It is time to take action on age and ageing
research.

EU
Funding for Ageing Research

    Patrick
    Kolar
    , Head of Unit, Health Research Directorate, DG Research,
    European Commission

They
are in a transition period between framework 6 and 7 for research.
First call for proposals for F7 has just been closed. He believes
that the EC has the ability to provide the critical mass Tom Kirkwood
described. FP5 ageing key actions include Food, Nutrition and Health,
where 190 Million euro of community funds have been invested, over
120 contracts granted, and where research is targeted at age-related
illnesses, demography, functional limitations, health and social
care, and determinants. FP6 actions include human development and
ageing (2002-2006), where 73 million euros was invested, 17 contracts
granted, and the research targets were genetics of “healthy”
ageing, fundamental development processes, mechanisms of ageing, and
embryo implantation. Other parts of FP6 programme include genomics
and biotech for health, combating major disease, combating cancer,
scientific support for policies, information science technology, and
science and society.

FP7
deals mainly with “Cooperation”, and runs from 2007 – 2013
(biggest so far), and has 9 themes: * health [this includes novel
approaches to reconstitute normal immune function at old age,
biomarkers of ageing, increasing participation of elderly in clinical
trials, impairment of touch and proprioception at old age, research
on human development and/or healthy ageing across the EU, and another
that I missed during the talk. The 2nd call due 18
September: understanding and combating age-related muscle weakness,
road-map for ageing research, translational research aiming for a
treatment of urinary incontinence, and a few others. The 3rd
call covers topics published “presumably” in spring 2008.], *
food, agriculture and biotech [this includes consumer and societal
aspects of food, nutrition- & diet-related diseases,
nutrigenomics], * information and communication technologies,
nanosciences, energy, environment, transport, * socio-economic
sciences and the humanities, and one other I missed. Those starred
are the ones that have a direct bearing on ageing research.

Other
funding possibilities include ERA-AGE, The European Research Network
in Ageing Research, which funds 15 national programmes
on ageing research 2004-2008 with 2.7M euros focusing on
interdisciplinary research. Other funding sources include the AAL
Ambient Assisted Living and the ERC, European Research Council, which
is the first pan-European funding body set up to support
investigator-driven frontier research.

Ageing
and Health: a global perspective

Alexandre
Kalache
, WHO

The
population in developing countries is fast increasing –
particularly the aged. There is no such overall increase seen in the
developed world. The 60+ bracket will increase
in both 1st and 3rd world, whereas total
population only increases in 3rd. (estimates from 2000 –
2050). However, the rate of “population at 60+” increases in the
3rd world are many times faster than that in the 1st
world.

Inequalities
– global extreme are exemplified in Japan (average lifespan 75.0
yrs), Sierra Leone (missed it, about 35). Social inequalities are
demonstrated in the extremes of poverty and luxury check-by-jowl in
places like Sao Paulo, Brazil. We must address these inequalities.

Ageing
in the development agenda: healthy older people are a resource for
their families, for example, older people are the principle carers
for AIDS patients and AIDS orphans in Africa. In Spain (2002), it is
the 75-84 age group that spends the most time caring for a sick
person at home (318 minutes per day), as opposed to 50 minutes for
the 30-49 age group. We need this older group to help with
caregiving. The developed world became rich before it became old.
Developing countries are becoming old before they become rich.

Life
Course: WHO interdisciplinary framework for guiding research and
policy on ageing. 2 billion older people in 2050 (what is the
classification of “older people”, though? He didn't define that
on his slide.). Active Ageing in the WHO framework is the process of
optimizing opportunities for health, participation and security in
order to enhance quality of life as people age. Examples of WHO
response include age-friendly PHC (primary health care) centres,
and age-friendly urban settings. Website at
http://www.who.int/ageing/en

Citizenship
and Society in an Ageing Europe

    James
    Vaupel
    , Max Planck Institute for Demographic Research

In
1840 Swedish women had longest life expectancy, at 45. More recently,
Japan has become the leader with life expectancy of 86 years
(Question: what is the statistical/computational difference between
average lifespan and life expectancy, if any?). This means a 40 year
increase in the 60 year period from 1840 – 2000. The trend has been
linear. The R-squared is .992 in terms of fit
to a linear scale for the increase in life expectancy overall
in Europe
: this is unusual in research! For a long period of
time (until 1950), there wasn't much progress in reducing mortality
after age 65. From 1970 onwards, this remaining life expectancy is
increasing by about 5 months per year (rehash of statistic first
presented by Tom Kirkwood). In all cohorts tested, the remaining life
expectancy over age 65 is increasing (in Sweden). For Japan, at ages
80, 85, 90, and 95, death rates are coming down, and the downward
slope is improving (the rate the deaths are coming down is
accelerating), even at the most advanced ages.

Why,
then, do so many people think it is so difficult to make progress in
this field? One reason is that most research is going on in the
states, and there has been very little progress in reducing death
rates for both women and men in the USA (the death rates at higher
ages, e.g. 85, are basically level). This is a major paradox. For
native-born white women, the curves look the same as the overall
curves, so it isn't due to changing ethnic mix.
Most European
countries are doing well: the only current exception are the
Netherlands.

It's
never too late to change. When comparing East and West German cohorts
of people born in 1900, until 1990 (reunification), the mortality
rate was lower in W. Germany, but after that the curves join up.

Japan could have life expectancy for women of 91 by 2050. The data
indicate that the majority of children alive today will live to see
their 100th birthday.

A
change in the mix of healthy and unhealthy people occurs as medicine
improves: you might expect that unhealthy lives are saved
differentially more than healthy ones. It turns out that this is not
true. Advances in medicine are such that the quality of life of these
unhealthy ones goes up, bringing them into the healthy range. The
reason we're living longer is that we're living healthily longer, not
because we're living longer while being unhealthy. Long-term
disability in Denmark: life expectancy went up, while the percentage
of people living with long term disability went down. Women more
likely to live longer, but also more likely to live with long-term
disability.

Europe
being the oldest continent is partly due to lower fertility: fewer
children skew the average. Since 1970 and 1980 there has been low
levels of fertility in Germany. Current levels are 1.3 (need 2 to
sustain the population without immigration). This tendency (< 2)
is true throughout the majority of Europe. In 1910 the population
distribution was a pyramid. By 2005 it became more like a pine tree
with a fat trunk, and estimates as time go on narrow that trunk.

New
work-life balance. One measure is ratio of non-workers to workers,
another is hours worked per week per capita. In Germany in 2005,
there was a ratio for the first measure of 1.27. Expected value in
2025 is 1.46 (16%). This means taxes have to go up correspondingly.
Measure 2 in 2005 is 16.28 hours / week (remember, this is over the
whole population). In 2025 it will decline to 14.95 (about an 8%
decline, which would cause a corresponding 8% decline in German
economy). The situation is roughly the same across all of Europe. USA
is with a negative percentage for a variety of reasons, including the
current low rate of increase in life expectancy. In Germany, people
between 30-55 work around 25-30 hours per week on average (across the
entire population), however, it tails off very rapidly on either side
of this age bracket. One solution is to increase the labour-force
participation of people 60-65 – raise from 10 to 20 hours per week.
More radically, could spread work more evenly. The 30-55 would be 25
hours per week, but that would continue to 65 before dropping to 15
hours to age 65 and then to 10 up to 75.

Panel
Discussion: Social Science Panel

The basic processes of ageing
are biological, but their impacts and meanings are societal and vary
between times, cultures, and societies. An increase in human lifespan
is explained by better nutrition, sanitation etc. Variations in life
span are genetic…

Social science of ageing
focuses on interaction of genes and environment in ageing, longevity,
health and functioning. Ageing is heterogeneous: big differences
between genders and ethnic groups, and a huge north-south gradient in
most of the dimensions of ageing. Ageing has an impact on family life
and social relations: grandparents around longer, the elderly may
still have childhood friends around them. Further, important factors
are negative stereotypes and ageism, which have to be changed to
promote age integration, participation and full citizenship.

Social science is
traditionally more country-specific and fragmented than biology.
However, there are some good existing Europe-wide programmes. One is
the key action from FP5 of “The Ageing Population and
Disabilities”, and the ERA-AGE FLARE programme (Future Leaders of
Ageing Research). Collaboration between social science and biology is
like a meeting of different cultures: difficult, but urgently
necessary. Multidisciplinarity does not grow on its own, but must be
nurtured.

Some suggestions for Europe.
This includes strengthening the position of ageing research within
universities: social, biological, psychological, and medical areas.
There is also a need to create established research environments for
ageing research in and within these disciplines. There is a need to
support multidisciplinary research training, and also to create
funding and platforms for multidisciplinary ageing research at the
European level.

The
rest of the talk was a Q&A, and represent personal opinions of
the panelists (except, where stated, they express my personal
opinion!) and not the opinion of the entire conference.

Question: Application of
social policy to the aged population in general seems to be low: e.g.
UK Food Standards Agency seems to have neglected things like amount
of salt intake for elderly as opposed to “average” people.
Answer: Public Health messages generally aimed at children's health
in relation to food, so this is a problem. However, many of the
messages are just as useful to the elderly, so shouldn't really focus
on either group (e.g. Some exercise is good for both age groups).

Question: How can elderly be
involved in the research process and not just be researched on?
Answer: Interesting social science issue (involving the subjects of
the research). He thinks that in general, the elderly are
increasingly being engaged. However, there is a worry that doing that
would encourage the elderly to go off on their own political agenda,
so the balance must remain intact (this sentence didn't make much
sense to me when I heard it, and neither does it make much sense when
I re-read it, but that's what was said). There is also a feeling that
the elderly, as subjects of the study, should be involved at some
level with the drafting of the study is being done. However,
researchers are a profession and it is difficult to include people
who are not professionals. More and more of the people doing the
research are, of course, ageing themselves. Therefore they could be
involved from both angles.

Question:
Is there any instance of research into longevity using twins? Answer:
There has been a lot of such research, and much of our knowledge
comes from such studies. The evidence is that identical twins have
more similar lifespans than fraternal twins, which are more similar
than unrelated individuals. From this, you can determine how much
genetic factors influence variation in lifespan (about 25% of
that variation is currently attributed to their genes) – not length
of lifespan. Even identical twins typically die about a decade apart,
so it isn't just genes. Also, identical and fraternal twins share the
same home environment, so childhood environment can be studied. From
this, it was determined that less than 10% of variation is due to
childhood environment. The rest of the variation is determined by
what you do today.

Question: In terms of the
ratio of healthy life to extended life, how do you determine these
two sections? How do you measure health? Answer: Based on
cross-section of studies and self-reported data. Don't just have
healthy/non-healthy, but healthy, mild problems, severe problems. Not
only do we now have longer life, but a longer life with mild
disability and a shorter amount of your life spent in severe
disability.

Question:
Present elderly population in Japan had hard work, vegetarianism,
etc. Today's young people have a very different lifestyle. Will they
be different when they age? Answer: Again, childhood environmental
impact is remarkably small. This is good news: even at age 90 and 95
it is possible to improve the health and longevity of people – a
remarkable plasticity. It is never too late to improve the ageing
process on an individual and large-scale
, and while the
mechanisms of ageing are largely physical, the impact of ageing is
largely social.

We lack data on many groups
within society. The socio-economic data needs to be improved. We are
mostly interested in promoting healthy ageing, but cannot forget
about providing for those who are not ageing in perfect health.

The
medical challenges of a longer life

Jean-Pierre
Michel
, European Union
Geriatric Medicine Society, Geneva Medical School

The most important challenge
is to prevent frailty and disability. Very difficult to do, as it has
to deal with different kinds of / heterogeneous life cycles
(variation in quality of life and physical ability).

Chronic diseases and
disabilities. For a non-disabled USA 65 year-old man, the percentage
surviving to age 80 AND being non-disabled is 26%, and for a similar
category of woman, the percentage of those surviving to 85 and being
non-disabled is 18%. In a group of 85+, the main causes for
disabilities are increasing age and frailty. There are twice the
disabilities in an 85+ group than in a 65-84 group. Frailty
is a transition state between robustness and dependence in ADL
(Activities of Daily Living). Modifiable risk factors to prevent
frailty include malnutrition, low exercise level, slow gait and
depression. Therefore frailty is reversible, where ageing is not!

In 65-84 age group the main causes of disabilities, in contrast to
the older group, are diseases (e.g. Diabetes, stroke and coronary
heart disease). These “adult” diseases will generally result in a
decrease in robustness and increase in mortality. There is a link
between a decrease in CVD (Cardiovascular diseases) mortality rates
and increased disability rates.

The second type of disease
important in ageing does not increase mortality but does increase
disability: it is called geriatric diseases, of which dementia is one
class within the type. Ageing is a risk factor
of dementia: diagnosis is generally 2-3 years after first complaint,
but the estimated start of the neuropathological changes is 10 years
before that. Therefore if you push the start of dementia forward by 5
years, you reduce prevalence by 50%. Risk factors for geriatric
diseases include BMI, Systolic Blood Pressure and cholesterol. The
dementia risk increases by 6.2-fold when these risk factorsare
combined (individually these factors increase by about 1.5-2 fold).

Risk factors for functional status decline are mental disorder,
burden of disease, low social contacts, poor self-perceived health,
and lifestyle (smoking, low level exercise, malnutrition, under or
over weight). Showed how higher consumption of fruits &
vegetables is linked to lower risk of stroke and heart disease.

We know now that the maximum
of bone mass density (BMD) is reached just after puberty in women
(16-18). The peak BMD is very different among women. 50% is exercise
& nutrition, and 50% genetics. Osteoporosis is a disease with two
types: with and without fractures, especially spine fractures. Risk
factors of spine fractures are protein malnutrition, low BMD, chronic
diseases and glucocorticoids treatments. He gave one group protein
supplements after hip fracture and another not. Those with supplement
have a significantly higher biceps strength and lower proximal femur
BMD, and also lower time spent in the hospital ward. In summary, it
is possible to delay the onset of dementia and osteoporosis, to give
better care and to decrease costs. Also, mid-life control of weight,
cholesterol, smoking habit, arterial hypertension will be very useful
in prevention of later problems. Even earlier, birth weight, physical
activities in childhood,and childhood diet are also important.
Finally, it is never too late to start reducing your risk factors.

Presentation
on Debate from the Medicine Sector Panel

Not sufficient to treat
diseases, but should also promote healthy ageing. When ageing was
absent (e.g. About 160 ago and before, when the population as a whole
generally died young), up to 50% of newborns died before puberty.
This is because the environment was much worse then: growing old was
an exceptional thing. When money came into our societies it was
possible to improve survival due to these environmental factors. Now,
almost everyone (90-95%) of newborns reach 65 years old. Before, it
was an environmental shadow, and now it is more of a knowledge
shadow. We have lots of knowledge about diseases of men in the 20s,
30s, 40s, but less about women and less again about diseases of later
life.

It is the loss of dignity and
esteem given to people as they age that leads to the lack of research
for and knowledge about old age and diseases of old age. In theory,
there should be a close collaboration between biologists who research
ageing and medical professionals. However, in truth there is very
little interdisciplinary work. They do not understand each other or
hold each other in esteem. Some countries have chairs in geriatrics,
but there are quite a few in the EU that have no chairs in
geriatrics.

Final recommendations are,
that while there are highly-qualified chairs of geriatrics and very
good research being done, more needs to be done to increase
interdisciplinary work. Should also attract and identify young
scientists, doctors, etc. Also, should shape organizational
structures to overcome the barriers between gerontology and
geriatrics. Finally, there should be good support of
clinically-oriented research into the as-yet poorly characterized
area of ageing research. When we measure attitudes of medical
students to geriatric medicine, the most important predictor was to
have had prolonged contact with their own grandparents.

International Association of
Geriatrics has now changed its name to International Association of
Gerontology and Geriatrics. Shows changing mindset, however the
fields are still far from being integrated. One possible way for
improvement would be to create Learned Societies for Geriatrics and
Gerontology in each country, or encouraging and supporting those that
already exist. It is important that funding bodies see that emerging
disciplines have these central bodies to support the researchers.

The
rest of the talk was a Q&A, and represent personal opinions of
the panelists (except, where stated, they express my personal
opinion!) and not the opinion of the entire conference.

Comment: One need is to create
a community of biology of ageing: unlike communities such as
the neuroscience community, there isn't really one for ageing.

Comment: 30/33 medical schools
in France have chairs of geriatrics.

Comment: For many older
people, the first point of contact is the GP. People who are running
some of the care homes in Newcastle say their main problem was with
the GPs and they are not familiar with the new exciting opportunities
for improving health of older people. GPs are saying “what do you
expect – you're ageing!”. You simply must re-educate many GPs.

Comment: Despite progress in
academic geriatric medicine, there are many European countries that
do not recognize geriatric medicine as a discipline.

Comment: The three learned
societies for gerontology, geriatrics, and social gerontology have
united as the British Council for Ageing.

Panel Summary Responses: The
time-shortage excuse given by many clinicians is just that: you
cannot say that you shouldn't be presented with the biology of ageing
because you're busy with patient care. There is no excuse to not have
connections to gerontology. Ageing occurs gradually, which does not
fit well with the reductionist view of many biologists. However,
ageing is a multi-faceted problem. This means you NEED a
multidisciplinary approach. “Systems Biology” is a key phrase and
a key answer to how to approach ageing research more holistically.

Living
in an Ageing World: a challenge for the individual and society

Ursula
Lehr
, Department of
Gerontology, University of Heidelberg

Perhaps it sounds better to
say “living in a world of increasing longevity”. There has been a
demographic change over time. North America and Europe has highest
average life expectancy at birth in both men and women. Life
expectancy at birth in the new EU countries in 2003 is lower than in
the original 15 EU countries.

The ageing population is also
called the greying society. In Germany, you belong to the youth
political groups until 35, and then 45 you are in the elderly groups.
In Germany, people live a life without a middle. In 2000, more than
20% of people 65 and older are in the European countries. This will
even out as time goes on, with other countries having older
populations. The decrease of the birth rate can be stopped by the
chance to combine job and family. It is necessary for women and men
to include job and family in their future plans.

The proportion between
different age groups has changed very much over time. In 1890, for
every person 75 and older there were 36 people in 0-20 age group, 23
in 20-40 and 15 in 60-75. Now, Only confronted with 11.2 people less
than 75 years old. Within increasingly poor health and low
well-being, ecological factors (housing situation, equipping of the
home, amount of social contact, etc.) increase in influence. People
with power in city planning and tourism must recognize this. In
general, to create an environment that is acceptable and humane for
the elderly is a challenge for the psychologist. Products, homes and
appliances must be easier to use than they are at the moment for the
elderly. Further, living arrangements of the elderly together with
younger family members are very rare. Families are less willing to
care for their older relatives than they used to be. In Germany
today, 3 people in labour force support 1 retired person – by 2040,
it will be a ratio 1:1 if continues as it is going at the moment.

Healthy ageing is defined by
absence of disease, psychological well-being, and the ability to cope
adequately with stress, health problems, limitations and handicaps.
Healthy ageing includes optimizing, prevention, rehabilitation and
management. There is a correlation between psycho-physical well-being
and longevity. It is, however, a complex group of interactions.

Unlocking
the Potential of Biological Ageing Research

Linda
Partidge
, University College
London

Mme. Jeanne Calment, February
1875 – August 1997 (122 years old), and smoked until age 109. About
700,000 suffer from Alzheimer's currently in the UK, and set to rise
to 1.7 million by 2050. It might sound obvious, but the biggest risk
factor of ageing-related disease is ageing. Therefore if we can
change the process of ageing we may affect the onset of
ageing-related disease. Dahlia anemone is, as far as anyone can tell,
non-ageing. Size isn't important, as for instance Brandt's bat (tiny)
can live for 38 years. The bristlecone pine can live for more than
5000 years. Each of these organisms is combating ageing in different
ways, as ageing is “controlled” by genes. Chimps can live to 59
years, much less than humans.

Each tissue system accumulates
its own peculiar array of pathologies as the organism ages. The style
and rate of ageing varies among individuals. There isn't a single
ageing process, but many different processes depending on the part of
the organism and among organisms. It could be, then, that different
organisms age differently, which would be bad news for gerontology,
as many non-human model organisms are used in ageing research (fruit
fly, c.elegans, mouse, yeast). By using these organisms, we
are presupposing evolutionary conservation. Fortunately, this
relatively pessimistic way of looking at things is incorrect. And in
fact, these organisms seem to be good models for human ageing.

C. elegans has a
peculiar behaviour when it is young and there are shortages of food
or crowding. It stops feeding, stores lipids and carbohydrates and is
very stress-resistant. In this mode it can survive for a very long
time. This is called a Dauer Larva. What happens if you express these
mutations in the adult worm? It leads to a long-lived strain of
nematode. This was in 1983.

In 1997, it was discovered
that this mutation was in the invertebrate insulin /insulin-like
growth-factor signalling pathway. These are healthy long-lived worms,
in that they remain active. It was thought this might be a worm
peculiarity. Later, they tried to find something similar in the fly
(Drosophila melanogaster), separated by the worm by 4 million
years. Two different mutations in the fly led to increased lifespan.
One was in the gene chico (insulin receptor substrate). This
suggested conservation between the two invertebrates, which has later
been confirmed.

There was some evidence that
mutations in insulin / insulin-like growth factor signalling affected
lifespan in mice. Yoda, a Snell Dwarf Mouse with a mutation in the
IGF pathway lived to be 4 years and 12 days old, the equivalent of
136 years for a human. This was also a healthy lifespan. Regulation
of blood sugar, their immunity (t-cells) and behavioural motor
function were normal and maintained longer. Also, delayed onset of
osteoporosis, cataracts, and (for mice) ulcerative dermatitis does
not happen at all. This gives us a way of doing the experimental
analysis so that we can ameliorate similar problems in human. There
are other pathways that are important in ageing that are also being
studied.

In humans, we also know that
blood glucose levels do correlate with quality of life and life
expectancy. Still, mustn't forget environment as a factor in ageing.
For instance, in mice and rats, caloric restriction to 60-70% (but
not malnutrition – has enough vitamins and minerals) of what they
would naturally eat produces significantly increased lifespan. Almost
all ageing-related pathologies in this case are delayed or prevented.
The mechanism of action is not well understood, as it has a
broad-spectrum effect. Works in a wide variety of organisms, but has
NOT yet been proven in rhesus monkeys or humans, for example. Steps
are being made in that direction using rhesus monkeys. Monkeys will
only tolerate about 75% of their normal diet. The animals in the
study are about 19 years old now, and they live until 30 so we don't
know yet. Early indicators are good, and show that the caloric
restriction does improve health. There have been short-term
experiments in humans. The southern Japanese population has a
cultural habit of eating far less than in the rest of Japan (18.5 per
100,000 versus 4.5 over the whole country), and has the highest
proportion of centenarians. Children eat 60% less than recommended,
and adults eat 20% less than national average.

The current research into
ageing-related diseases are done mainly independently – each
disease is studied independently and go to their own meetings etc.
However, it isn't that simple. In future, a more promising strategy
would be to treat the ageing process itself, which will then have a
knock-on effect on all those ageing-related diseases. This requires
interdisciplinary, collaborative teams of basic and clinical
scientists and clinicians.

Presentation
and Debate on the Report of the Biology Sector Panel

The molecular mechanisms of
caloric restriction (and its benefits) are not well understood.
However, genomics, proteomics, metabolomics may help. Contributions
of Europe to biogerontology has been good in recent years: EU
Framework Programmes (GEHA, MIMAGE, PROTEOMAGE, LIFESPAN, LINKAGE),
research centres on ageing (Aarhus, Ancona, Innsbruck, Newcastle –
IAH), and research successes (proteasome, telomere, mitochondria,
premature ageing, biobanks, genetic scans, health ageing).

Reaching critical mass at a
national scale is important for ageing research in Europe. This
includes training and education, national centres for excellence, and
national ageing research networks. Also, capacity-building at a
European level is needed. This parallels the national list, and
includes EU networks, European Centres for Excellence, etc.

The funding for biogerontology
is very much less than funding for age-related diseases. By
increasing funding in biogerontology, could reach a critical mass of
research and get to a number of scientific breakthroughs. Deliveries
would include parallel genomic, proteomic, & metabolomic
profiling of ageing subjects, biomarkers of ageing, identification of
longevity assurance genes, the development of successful healthy
ageing strategies, etc. They forsee that in 10 years extensive
databases will be in place that include the biomarkers of ageing, and
nutritional and healthcare products to increase the number of people
in a healthy ageing process. 50 years – personalized medication of
the elderly.

The
rest of the talk was a Q&A, and represent personal opinions of
the panelists (except, where stated, they express my personal
opinion!) and not the opinion of the entire conference.

Question: If one gene affects
longevity so much, how come it hasn't happened naturally yet? Must be
a selection against longevity? Answer: Remember that it is part of a
signalling pathway, therefore we're at the top of a whole hierarchy
of gene expression. Genes at the top-level pathway affect the system
to a greater extent. Further, the mutation hasn't occurred naturally
perhaps because of environment. The selective pressure would be to
reproduce quickly, and these mutations might slow down that
reproductive process, perhaps in non-obvious ways.

Question: Given the financial
state of the UK's NHS, how can we bring pressure onto our governments
to bring about these changes that are talked about in 10, 20 and 50
years? Answer: We need larger-scale facilities, e.g. One that is up
now that wants to study longevity by following 10,000 individuals.
Need large-scale coordination to make this work. Not a great answer,
but it is a hard question.

Question: In the US, there is
a big drive to find a caloric restriction memetic (?). He wants to
know if the panel thinks this will work. Answer: One personal view of
a member of the panel: what is better than a memetic or pill would be
simply to change the behaviour of the population. Safer and cheaper.
However, it may not be realistic or within the power of many people
to voluntarily restrict their own caloric intake. So, alternatively,
the trick might be to get the cells to do what they do without the
nutritional impetus of caloric restriction.

Question: Women live longer
than men. Is there any sign of science reducing that gap? Answer: No
answer, other than the burden on the daughters of caring for everyone
will reduce their lifespan 😉 (== joke).

Question: Gross domestic
happiness / happiness indexes for the elderly wasn't mentioned at
all. In future, would you include this in research? Answer: You've
asked the wrong people. (My personal opinion is that this was a very
bad answer to a timely question. If she didn't know, she could have
asked the panel – which strangely she didn't – or open the answer
up to the audience.)

Question:
Is caloric restriction good because it makes them slim? Answer: It
isn't clear that the benefits of caloric restriction come from being
low-fat. Someone tested calorie-restricted – but obese – mice, and
they lived as long as calorie-restricted wild-types. Therefore there
may not be a relation between BMI and health – YOU NEED A BETTER
MEASURE! The mouse that are long-lived also show a mix of phenotypes.
Some are insulin-sensitive from birth. Others start life as mildly
glucose-intolerant, but as they age they cross and then overtake the
control and becomes glucose sensitive. It's not clear what is
happening. What they all do is up-regulate cellular regeneration
mechanisms, so that may be closer to what is influential. If you look
at humans who live very long (i.e. The families that live longer than
their birth cohorts generation after generation), one thing we know
about them is that they do have normal BMIs. They don't have a lower
BMI than their partners, for example. It isn't just your size.

Technologies
to Enhance Older Age

Willam
Mann
, University of Florida

What is Assistive Technology
(AT)? These are devices that make doing tasks easier. Examples
include a walker, a bath bench, ramps, jar openers, denture brush
holder (i.e. One-handed denture cleaner), light sensors, vibrating
alarm clock (quietwake), assisted listening devices, phones with
pictures rather than numbers.

Is AT accepted by the elderly?
Study done 1991-2001 was a consumer assessment study. Almost 3000
interviews were done. The elderly owned about 14 devices and used
about 13, and were satisfied with about 90%. However, is AT
effective? There have been studies in the past 10 years that focused
on this question. One compared personal assistance to assisted
devices. The devices were more effective (or is that that people
preferred doing things on their own?) Another found that preventing
falls by installing appropriate devices in the home helped a lot.
Another looked at modifications to the home and addition of devices,
and found that the level of independence increased and the level of
mortality decreased. His group did a 4-year study on those that had
normal home-care service versus extra-special care and help. They
found that the percentage points of decline on two measures of
functional independence was greater in the control group. They also
looked at cost of care of control (21, 847$) versus those with extra
help (5,630$). At the end of 4 years, this went to Control (177,637$)
versus intervention (93,089$). Even with these impressive numbers, it
is still hard to get public acceptance of this, though. Another study
was 2002-2004 VA Demonstration called LAMP: Low ADL Monitoring
Program. Differences between 6 months prior and 6 months post
intervention were things such as 80% less hospital admissions, 95%
less Bed days of Care (BDOC), 39% less ER Visits.

Is the technology advancing?
Take one example: history of hearing aids. 1700: ear trumpet. 1800:
combined eye and ear trumpet, or combined with a vase for flowers to
hid it! 1953 first pocket-model. 1957 hearing aid combined with
eyeglasses. The 1970s included first entirely within the ear, so on
and so on. In the future he sees many advances. First TV sold in
1938, one year before the first broadcast (!), and was predicted that
every house would have one by end of century. Ray Kurzweil (a
“futurist”), wrote (among others) The Singularity is Near.
Some of his predictions are wild: in 10 years, we'll be able to eat
as much as we want without gaining weight. At end of century, barring
accidental death we'll be able to live as long as we want. Wetware
(Personal note: this guy did NOT think of this – it's been in sci
fi books for years!). He suggests that the pace of our technological
development is exponential, not linear.

He is working on smart houses,
their specific example is a “gator-tech” home. 2500 square feet
where grad students can stay and watch what's going on. Location
monitoring can be done using sensors in the floor so the home knows
where a person is. Smart front door so they can see who it is from
whatever room they're in. Also, he is working on mobility. The smart
house has a driving simulator. Robotics as personal assistants.

Why is AT not widely used?
We're really looking at two different models of helping people with
impairments. One promotes independence through adjusting the
environment, the other uses a caring model with elderly dependent on
assistance.

Presentation
and Debate on the Report of the Technology Sector Panel

Thought about technology in
general, and not just AT. Which technologies will benefit which
people? They propose three levels of need. The first is the informed
level, or using technology for the promotion of healthy living. The
next level is the Supported / Empowerment level. This level would use
simple technology that is always appropriate to need, and will be
used to maximize independence for as long as possible. The final
level is the Dependent level, a.k.a. the technology for Independence
level, for people who are completely dependent on technologies. This
is the group for which the latest new technologies would be most
useful.

The benefits of Informed stage
is the prolonging of healthy life and the delay of transition to the
support stage. The problem is getting people to engage. The supported
level would include support for mobility and social interaction.
Included in this level are total joint replacement, use of the
internet. Also needed would be ways to increase their exercise, both
classical (walking, dancing) and technological (robotic help to
exercise). Also important for self-esteem is self-care and personal
hygiene. Finally, mental well-being, including mental exercises, is
important for this level. The benefits include preservation of
independence, but the problem is that all must buy into the idea of
inclusive design. For the dependent group, personal emergency
response systems are already available. Automatic cardiac support
systems are also already available. Autonomous smart homes being
developed. Benefits include that it maximizes safety at an acceptable
cost. Problems include the big brother effect: is it big brother or
is it a cuddly computer? Also, everyone who might use the system must
feel comfortable using them.

Design is really important in
developing these technologies. The use of inclusive design should be
here now. Should optimize the matching of technology solutions to
people. Should develop methods to empower people to monitor key
health variables, smart *, advanced communication technologies, and
more. Engineers had a major part to play (e.g. improved sanitation)
in increasing longevity, and mustn't forget that now, in the age of
biological and social research. Remember, the attitude of the general
population to people with disabilities varies by country, and should
be taken into account when developing AT.

The
rest of the talk was a Q&A, and represent personal opinions of
the panelists (except, where stated, they express my personal
opinion!) and not the opinion of the entire conference.

Question: On one hand you have
technology development. On the other, regardless of ageing, we're in
a world where IT is moving forward quickly, and many are struggling
to keep up. Do you have any ideas on making computers more
easy-to-use, including trying to modify the design of computers
(rather than just training)? Answer: The process of developing new
technologies is a problem-solving exercise. Therefore,
multidisciplinary approach is important. For AT, users are involved
from early on. (My personal opinion is that this was a very bad
answer to a very important question. If they didn't know, they could
have opened the answer up to the audience.)

Question: How can the design
process be improved and “taken forward”? There has been a
tendency, when designing AT, for it to be on behalf of these older
people, and not with the elderly. Answer: User-led design has
matured and is becoming more prevalent: many more activities in the
development process now involve input from the users. However, there
is still more room for improvement. Bad design will always be with
us, even if inclusive design is taken up completely.

Question: a lot of the smart
technology looks like it would be useful for everyone, young and old.
However, she read somewhere it would cost 10,000 euros to add a
stairlift, and 1,000 to put it in when building the house. Has there
been any work or discussion with builders? Answer: The more we can
make design inclusive and appropriate, the more we have the
possibility to make the object low-cost and large-scale. Example:
central locking of windows and doors. If everyone wanted it and was
installed in all new homes,would no longer be a thing specifically
found in a smart home. In terms of the question specifically: homes
have a long lifespan, so the focus must be on rendering the home
readily adaptable, rather than installing devices that might become
out-of-date. Smart homes are expensive, but the potential benefit –
both in cost and independence, is quite high.

Economic
opportunities of increased longevity

Robert
Diamond
, Founder and CE,
Diametric

Will talk more about the micro
aspects of economic (what are people willing to pay a premium for?)
rather than macro aspects. Spend a lot of time working with large
consumer brands. They are interested in why consumers buy things, and
why older consumers choose particular items? 91% Of the UK population
over 65, but only 11% still have mortgages. 72% of stocks &
shares holders expected to retire by 65? After recent market decline,
on 31% expect to retire by 65. Over 50s enjoy spending time with
their parents the least. Top response (20.5%) to what over 50s enjoy
most: having sex.

Over 50s headlines (UK): they
are the fastest-growing demographic group. 20M people today, rising
to half of the UK population in 20 years. Also, fewer younger people,
which affects how money is spent in targeted marketing. Over 50s old
80% of asset, 60% of savings and 40% of disposable income. However,
40% of over 50s rely entirely on government pension. Globally, over
50s have the highest spending power in developed countries. Over 50s
spend 60% of the total money spent on luxury cars, 55% of coffee, 25%
of toys, 50% of mineral water, 70% of cruises, 50% of cosmetics, 40%
of home PCs, 37% of spa visits. In food, inflation in the cost of
food has increased. This is driven by the growth of the organic food
market, etc. In Health & Beauty, Cosmoceuticals/Neutriceuticals
are a big market. In DIY, increasingly called the DIFM market (Do It
For Me), as buying product + installation services are increasingly
popular. There is also an important point of Seniors as
“gatekeepers”: they buy 38% more confectionery than they eat
themselves. The financial outlook for over 50s (or soon-to-be over
50s) is getting gloomier due to falling incomes, rising costs, and
greater aspirations. Also, over 50s face major pressure at home: 1 in
10 care for both parents & grandchildren. 60% of over 50s still
have living parents. Also, helping out with grandchildren is common.

The buying behaviour of older
consumers is discussed next. Age is an influence on how consumers buy
things. Over 50s do indeed shop differently. The majority of the
factors are less important as you get older. The only exception in
this study is buying from a trusted retailer, whose incidence
increases with age. There are an increasing number of ways to shop:
retail, internet (including “recycling” market such as eBay),
catalog, etc. In that context, the majority of over 50s use the
internet, though broadband penetration isn't as high yet. 45% of over
50s use the internet to buy products or services. There is an
increasing role of social networks: “geriatric1927” on youTube,
for example.P2P is more important in the over 50s than in any other
group. Loyalty programmes, including dedicated loyalty programmes for
older people, generally don't work on senior consumers. However,
immediate discount offers do work.

Brands and the ageing
population. Brand loyalty is NOT high in senior consumers, as many
have assumed. Though loyalty is generally at about 71% (percentage
who would like to stay with the same brand), they would switch if
they found a better deal. Many marketers ignore or misrepresent over
50s (e.g. Tesco's and the Mother/daughter ad campaign). There is a
worry that appealing to older consumers would alienate younger
consumers. Alternatively, about one-third of 55+ boycotted products
they thought misrepresented them. There are limitations of
generational targeting, as there is more than just age involved: also
gender, physical characteristics, race, wealth, and outlook. How
should brands be targeted? What he wants is a return to
cross-generational marketing: retaining things you want (strong
brand, place on the shelf), but add a simpler approach (focus of
message, ability to retain customers as they get older). Also, use
something called proposition development: is it best to talk to over
50s as a generational group? Do you want to be seen to be selling old
things to old people? It's actually more significant to talk to
people with shared values, shared value, shared needs, and shared
lives (rather than trying to talk to them with specific ages in
mind).

Presentation
and Debate on the Report of the Finance & Industry Panel

Perceived societal pressures
include future loss of EU-GDP and therefore competitiveness, the
pension crisis, financial pressures on health services, and healthy
life expectancy. He believes that health & longevity create
value, and one study says that the value of cumulative gains in life
expectancy is $1.2 million per person, and increased longevity added
$3.21 trillion/year to national wealth. Also, reduced mortality from
CVD has increased the value of life by $1.5 trillion/year since 1970.
In 2006, when the health research activities were recorded (combined
spending of NHC, MRC, etc…), ageing research is not even on the
map. Further, prevention research is funded at the low end of the
spectrum: only 2 1/2% of spending is on prevention, when payback is
much higher than most other types of research. The most important
issue for most older people is self-worth.

The
rest of the talk was a Q&A, and represent personal opinions of
the panelists (except, where stated, they express my personal
opinion!) and not the opinion of the entire conference.

Question: It seems that you
market the 50+ market as just one group. Do you see the 50- market as
another group? Answer: The sophistication of marketing is higher in
teenagers and young adults, who has far less money. Just goes to
illustrate how the marketing industry has failed to follow the money.
However, the financial services have managed to do this. Another
issue would be the still-pervasive stereotyping of older people as
poor, whereas much of the wealth is now in that age group.

Question: Rolling Stones are
older now, and even though they made “young” music, old people go
to see them now. Can you elaborate? Answer: For this example, there
are a whole swathe of bands who are doing this, but the theme is more
about revisiting your golden years, rather then targeting the young
market. There is a correlation between the rebirth of many luxury
brand houses and ageing consumers who knew these brands when they
were younger (and had less money).

Question: What is the evidence
base (particularly economic) for the statement: “people who are
healthier mentally are healthier physically?” Why raise fees for
getting exercise when it would help the elderly in multiple ways?
Answer: None.

Question: European
horticulturists are panicking at the moment because “no-one wants
to buy fruit & veg any more”. Can you comment? Answer: None.

Changing
Expectations of Life: How to Make it Happen (Panel Discussion)

Led by Tom Shakespeare,
Social Scientist at Newcastle University

We should find a balance
between optimism/utopianism and fatalism. Can we perceive ageing as a
fault or defect? If you think this way, it is an example of utopian
thinking. Vulnerability is a characteristic of ageing cells and
ageing people, but should not be associated solely with the elderly.
In that utopia, we would like to imagine no limit on the human
lifespan. Why does a mouse live for 2 years, and the closely-related
species the naked mole rat, lives 30? All of these additive faults
and defects can be looked at not as machines that go until they stop:
we are a completely different bunch of molecules than we were when we
were born. What are the patterns that make us up in this stream of
cellular turnover? Without regeneration and maintenance of our
bodies, we couldn't live longer than a few days, so there is a large
assumed reliance on regeneration. Should think of regeneration as a
default mechanism, and what ages us is the exception, not the
norm.

Why is there not a closer fit
between gerontology and geriatrics? We need to manage stereotypes
much more than we are right now. There are tremendous pockets of
poverty and frailty and ignorance, and we need to address them. For
instance, Spain has an incredibly high life expectancy, but there are
people who are eating much more, so is that life expectancy
sustainable?

Through short-termism,
policy-makers and providers work the wrong way around. Instead of
looking at the cost of healthcare as an investment, they are doing
short-term cost-cutting. For example, the recent decision to only
allow the new Alzheimer's medication to those patients who have the
more advanced disease just moves the cost from the NHS to the
Department of Work and Pensions. She also thinks that there is a lot
of hidden marketing to old people. Many older people feel like the
only people who understand them are other older people. Also, the
“last taboo” is death: we can talk about sex, but not about
death.

Another suggestion is that
what we do at these conferences aren't taken up by the government.
How do we get them taken up? We must make it public, and loud. A
suggestion was made that disability groups and age action groups
should work together.

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