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Disease in old age

People in the world are living longer due to better access to advances in medicine and technology. By 2050 it is estimated that two thirds of the world's population will constitute the elderly. Better diagnosis and treatment of disease has resulted in longer life spans. However, this has also revealed a new era of aging associated diseases ranging from cancer and degenerative diseases of the brain, to obesity and heart disease. Age-related disorders have become widespread throughout the world.

Science has always been fascinated by the process of aging. How and why we age has been intensely studied across organisms as diverse as soil nematodes, fruit flies and zebrafish, all in an effort to understand human aging. The aging body undergoes several changes at the tissue, cellular and molecular level that are irreversible in nature. Cells accumulate damage at multiple levels via changes in cellular biochemistry, altered gene expression, changes in metabolites and macromolecules that lead to damage at the systemic level and altered behavior. Research has shown that many conserved cellular processes regulate molecular events associated with aging. These changes are due to several factors including genetic predisposition, diet, level of physical activity, ethnicity, the environment we live in, and even our state of mind.

One of the primary outcomes of aging is an increased risk for disease and death. Currently, about two thirds of the people who die every day, die of age related causes. The natural process of aging together with genetic and environmental factors makes the body more vulnerable to disease. Often, chronic conditions develop between the fourth and sixth decades of life. As the body ages, the ability to ward off disease diminishes. Further difficulty arises because older adults display extremely heterogeneous manifestations of disease and hence treatment strategies require careful thought. Clinical presentations are often confounding and therapy is not as straightforward. Co morbidities and life expectancy determine the nature and structure of therapeutic interventions.

For centuries people have tried different means to slow down the aging process, be it external body shape or internal body composition and mental wellbeing. Healthy lifestyle choices can slow down aging to some degree. Yet, not all these means and choices are available to every aging adult. Also, we cannot choose our genes and they clearly do play a significant role in determining disease risk of an individual. Researchers are trying to further understand this link between aging and associated disease. Collaboration between various specialties like cellular and stem cell biology, epigenetics, metabolomics and neurobiology of the brain and behavior are being forged, to throw light on the mysteries of aging and disease.

As longevity increases and disease inevitably sets in, the focus is not only on treatment and therapeutic intervention, but science and medicine is also moving towards developing strategies by which the best possible quality of life can be offered to those elderly suffering from various ailments. Easy accessibility to affordable healthcare and well equipped and functional elder care institutions are ways in which disease can be mitigated and better managed. There may not be any escape from old age but there can be effective means to make the process less painful.

Dr. Sarada Bulchand
Duke-NUS Graduate Medical School, Singapore

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