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Biology of Aging
Siri Rostoft, MD, PhD
Department of Geriatric Medicine
Oslo University Hospital
Norway
Disclosure
No conflicts of interest to declare
Patient, 96 years
“ ……you know, I am not
80 years anymore…….”
Who is older?
• 10 years older than the treating physician
• Literature: varies from 65-75 years
DISPOSITION
• Life expectancy increases
• Longevity
• What happens to the body when we age?
• Heterogeneity – fit versus frail
• Aging biomarkers
Life expectancy increases
•UK: Life expectancy increases
at the rate of 5 hours per day¹
• Why declining late-life
mortality?
¹Kirkwood Nature 2008
100 Years Old. 5 World Records.
The New York Times, September, 2015
QUIZ
• What is the percentage of people aged 80 years who are independent in their daily life?
• 20%
• 45%
• 75%
What about functional status?
• The majority of people who are 80 years have
a good functional status and live independent
lives (75% in Swedish study) even if they have
chronic diseases
• Often large changes in health and function
between 80-85 years
Santoni et al Plos One 2015
Death rate in older people
• Most babies born since 2000 in France, Germany,
Italy will celebrate their 100th birthdays
• Extreme longevity = extreme disability?
• The answer is still open
• Difference between population level and
individual level
Christensen et al, PNAS 2008
Danish study
• Proportion being independent around 0.4 in
all ages, 92 to 100
• High rate of mortality among the most
disabled at any time
• 90 – only halfway to 100 (0-92 1:30, 92-100
1:30)
Christensen et al, PNAS 2008
Getting better (population level)
• 1915 cohort performed better than did the
1905 cohort in cognitive functioning and ADL
• No differences in performance measures
• ADL better due to better cognitive functioning
and better living conditions
Christensen Lancet 2013
Declining prevalence of dementia
• A reduction of 24% of dementia in two
cohorts in England and Wales1
• Participants in the Framingham Heart Study
– incidence of dementia has declined over the
course of three decades 1980s ref to 2010
– 22%, 38%, and 44%2
1Matthews et al, Lancet, 20132Satizabal_NEJM_2016
Quiz
• What is the most common cause of mortality
in people under the age of 85?
• What about people over the age of 85?
• Alternatives
– Cancer
– Heart disease
– Infectious disease
Causes of mortality (US)Death rates of cancer and heart disease for ages younger
than 85 and 85 and older
What is aging?
• Defined as
– Progressive loss of function
– Reduced fertility
– Increased risk of mortality
• Deteriorative process
1. Increases probability of dying
2. Decreases ability to withstand extrinsic stresses
Kirkwood Nature 2000
Natural selection and aging
• Species that have a long lifre span live in a
protected environment (humas)
• Age-related diseases often occur after
reproductive age – the genes are not removed
• Aging leads to accumulated damage – good
genes for repair and maintenance lead to
better aging
Aging
• Happens due to biological processes
• Biological processes lead to changes in
physiological variables
• The calendar cannot be used to measure aging
Arking: Biology of aging, 3rd ed
PHYSIOLOGY OF AGING
Aging - levels
• DNA
• Other molecules, cells
• Free radicals (important to kill bacteria,
negative for aging)
• Tissues and organs
• Organ systems
• System level
“After age 30, it is all downhill”RA Marottoli, 2011
Physiology of aging
1) Mortality increases with increasing age
2) Body composition changes with increasing age
(muscle is replaced by fat)
3) Decline in capacity with increasing age (maximum
pulse↓, kidney funcNon↓)
4) Reduced capacity to deal with stress (surgery,
infection), difficult to sustain homeostasis
5) Increased risk of disease and increased vulnerability
when getting sick (i.e. pneumonia)
Reduced ability to deal with stress
Lakatta Aging 1994
Decrease in capacity - heterogeneity
Muravchik, Anesthesia 5th ed, 2000
25
Forventet gjenstående levetid
Walter LC, JAMA 2001
Remaining life expectancy
Healthy aging
• The ultimative preventative medicine
• Age is the greatest risk factor for nearly every
major cause of mortality
• Biomedical research focuses on individual
disease processes
• Should focus on molecular processes that
underlie biological aging – particularly on
interventions that delay aging
Kaeberlein et al, Science 2015
• Multimorbidity
• Polypharmacy
• Functional disability (need assistance in everyday life)
• Cognitive impairment or dementia
• Malnutrition
• Lack of social network
• Evidence-base is non-existing
GETTING OLDER….
BIOMARKERS OF AGING
Why do we need biomarkers?
• Calendar is insufficient to measure aging in
individuals
• Are there biomarkers that could help us?
Ideal biomarkers
• The rate of change with time in a biomarker
should reflect the rate of aging
• The biomarker should be monitoring a basic
and important process
• Nonlethal and preferably noninvasive test
• Highly reproducible results
• Functions being measured should be curcial to
maintain health
Arking, The biology of aging, 3rd ed
• Biomarker should be able to funbction as a
prospective predictor of life span
• 1) Predict outcome of a broad range of
physiological domains, better than
chronological age
• 2) Predict remaining longevity
Examples
• Grip strength – predicts premature mortality
in men >60 years
• FVC (forced vital capacity)
• White blood cell count
• Cholesterol (age specific)
• BMI (age specific)
Visual estimates
1. Older looking twin dies first Christensen et al. BMJ 2009
2. Residents’ illness severity ratings were the most
significant predictor of in-hospital mortalityCharlson et al. J Chron Dis, 1986
3. Individuals who looked older were biologically
olderBorkman Soc Sci Med.1982
Biomarkers of frailty
• One may look at aging as a pro-inflammatory
state
• “Inflammaging”
• Increased sectretio of pro-inflammatory
cytokines
• Examples: CRP, IL-6, TNF-α associated with a
higher risk of all-cause mortality
• Frail individuals have higher levels
Other biomarkers
• D-dimer (aging associated with activation of coagulation?)
• Telomere length – decreased length=associated with mortality and disability
• Glascow prognostic score (measure of systemic inflammation based on CRP and albumin)
www.pnas.org/cgi/doi/10.1073/pnas.1506264112
Used biomarkers from people aged 26-38 to calculate pace of aging. Based on clinical
examinations, examples were BMI and cardiorespiratory fitness
DNA methylation age – epigenetic
clock• Epigenetic signatures show a strikingly accurate way to
measure human aging
• Modifications to the genome that does not alter the DNA sequences but can influence how genes are expressed
• The method allows for estimation of DNA methylation age of most tissues and cell types
• DNA methylation age measures the cumulative effect of an epigenetic maintenance system
Horvath S Geome Biol 14 (2013)