Why Aging Matters: a Multidisciplinary Perspective

Introduction

Despite the stigmatization of aging as a single, normative, and ubiquitous process that triggers incremental declines in somatic and mental health, aging is, in fact, deep, multidimensional, and highly individual. Moreover, aging has become an increasingly important, cutting-edge topic in the social sciences and humanities, as well as in the physical and life sciences. We are now encouraged to think of aging as a ""pleasure"" as well as a pain, a process that society will undoubtedly show as much diversity as heterogeneity.

Aging will be influenced by a number of biological and social conditions, which will lead to different experiences of ""successful"" and ""unsuccessful"" aging. The biological sciences can contribute to our understanding of why and how the human body will survive and change over time, and under what conditions disease and disability will change. Social sciences will inform us how people interpret and attach meaning to their aging, and how these interpretations and meanings vary across and within different social, cultural, and time settings.

From a historical and global perspective, we are collectively moving from an age where the survival and well-being of hundreds of millions of very young children under the age of five were seen as the inherent measure of success. Today, the major challenges, at least in the West, are adult morbidity and mortality, including those related to aging. The number of people who can be classified as elderly or older people is increasing rapidly around the world. As such, concepts of ""successful"" and ""unsuccessful"" aging are necessarily drawing our attention in multiple disciplines and policy spheres. Social and political theorists have been exploring aging from ancient times, although prior to the mid-twentieth century, people over 60 years of age were not considered a politically important constituency. However, most agree that the massive increase in global aging has taken us into uncharted ""hyper-aged"" territories for which there is no existing political or social methodology. There is now much support to bring different disciplines together to investigate the problems associated with growing elderly populations while investigating possible opportunities associated with population aging.

Biological Mechanisms of Aging

The cell has long offered insight into human development and adaptation, while offering a complementary viewpoint to existing explanations of various phenomena. This part of the course takes the perspective of the cellular biologist or geneticist and examines what cellular and genetic sciences are able to say about human aging. The topic has gained currency in recent years. We will briefly review the theories and processes.

One of the most important changes within the cell with age happens in the G1 phase of the cell cycle: the induction of cellular senescence. In tissues that experience senescence, only a few cells will express the controlled form of terminal differentiation called replicative senescence. In others, all cells will senesce. These two events rapidly alter how cells communicate with each other in order to protect their tissues from metabolic discontent and prevent the initiation of neoplasms that may result from too many cells accumulating an oncogenic mutation. Senescent cells change the types and amounts of proteins and lipids that they release to help modify the function of healthy cells. They may also change the way they respond to the extracellular environment, including how much of a cell wall-degrading enzyme they secrete. They may stimulate inflammation and encourage the immune system to eliminate the local tissue they reside in as a wound healing-unrelated foreign pathogenic object. In healthy, fully functioning tissue, senescent cells may slow the growth of their neighbors, ideally providing time to eliminate damaged cells and maintain a constant density.

Cellular Senescence

This work provides a comprehensive examination of aging from a multidisciplinary perspective. It includes contributions and collaborations from an international team of researchers and scholars. Drawing from the humanities, social sciences, and natural sciences, it offers a detailed look at background history, personal experiences, policy developments, and current research in aging. It covers numerous aspects of the aging process from various perspectives. This handbook will be of great interest to scholars and researchers across different disciplines interested in a well-rounded treatment of the history and development of aging. This four-volume set provides an overview of aging research, new directions in theory and paradigm development, methodological innovations, and insight into future research directions. It draws a range of scholars from different disciplinary backgrounds who engage with contemporary studies on aging.

Cellular senescence is the phenomenon whereby cells withdraw from the cell cycle. Over the past years, we have learned a great deal about how signaling pathways converge to drive cells into senescence and the far-reaching consequences of this profound change in cell state. Cell senescence is often induced by persistent DNA damage and stress. Triggers of the senescence response converge largely on the p53 and pRB pathways. Senescent cells contribute to tissue homeostasis during development, wound healing, and tumor suppression. However, persistent accumulation of senescent cells may have negative effects on tissue function and organismal health, and various interventions to clear senescent cells in laboratory models have demonstrated health benefits. Although a concept introduced by Hayflick as recently as the 1960s, cellular senescence has since become an important focal point of current gerontology research, with increasing understanding of the signaling pathways that drive senescent programs and lead to unique phenotypes. Studies are already underway investigating therapeutic clearance of senescent cells. Senescent cells have been identified in a number of age-related diseases. They have been shown to drive fibrotic diseases in the lung, impair neuronal health, and drive Alzheimer's disease, and have been identified in atherosclerosis.

Genetic Factors

Over the past few decades, the study of aging has been dominated predominantly by the role of environmental and behavioral factors, despite significant evidence to suggest that a predisposition to age-related diseases is, in part, governed by heredity. Studies from the early 20th century demonstrated that heredity could be a significant determinant of lifespan, with approximately 20–30% variation in mouse and human observational studies indicating that genetic variation could play a significant role in determining the average length of life. More recently, it has become evident that the genetic factors which control an individual’s health span or lifespan, with certain genetic variations having been identified to predispose individuals to certain age-related diseases. This all corresponds to one key message, driven ever more by rising life expectancies, that an extension in an individual’s lifespan does not automatically equate, nor guarantee, a health span.

Recently, through the use of insight from genome-wide association studies of diseases that have an age-related etiology and through a variety of different model systems, a growing catalog of genetic loci is being recognized as determinants of the way an individual ages. Often, genes that have been identified to contribute to the process of aging and age-related disease progression are involved in fundamental cellular processes of energetic and signaling metabolism as well as stem cell function. This approach has begun to see advances in the identification of other genetic determinants also associated with lifestyle and environmental factors that have been shown to result in changes in gene expression, the field of epigenetics.

In addition to the aforementioned characteristics, genetic determinants of diet and metabolism have also been identified as potentially significant, whereby smaller populations with inherited metabolic traits that affect aging phenotypes have been recognized. Overall, identifying various contributors and, consequently, potential therapeutic pathways to aging and age-associated diseases has heavily relied on discoveries in genetics. It is increasingly important going forward to understand each of these genetic, cellular, and physiological factors if we are to promote a potentially more effective and more personalized approach to improving the aging phenotype. Future research can start to work on the potential interrelations between aging subcategories and generalizable versus metabolism and lifestyle-based aging determinants.

Inflammation and Aging

Because aging is associated with an increased susceptibility to infection, an increase in the time needed to recover from infections, an increased risk of cancer, a decreased capacity to respond to vaccination, an altered distribution of hair color pigment cells, and even hair loss, one might propose that aging is simply due to a gradual accumulation of encoded molecular interactions that make seniors more prone to getting sick. An alternative explanation suggests that slowly but steadily increasing chronic low-grade inflammation is the driving force of the aging process. The term ""inflammaging"" recognizes the fact that many conditions in subclinical asymptomatic older persons can be at least partially explained by slowly developing proinflammatory changes. Other features that are consistently associated with aging include increased insulin resistance and mitochondrial dysfunction.

Recently, inflammation has gained much attention in the field of gerontology and geriatrics. A biological basis for these associations was established extensively in the field of cellular biology. Many of the markers are related to inflammation and are focused around three groups of major alterations that occur with aging: 1. alterations of cytokine secretion; 2. cellular indicators, such as quantitative and qualitative defects in T and B cells and in monocyte count; and 3. alterations of costimulatory molecules. Systemic effects of inflammatory processes on functional systems in humans may involve physical, psychological, and cognitive aspects of human health. Interventions such as a calorie-restricted diet, rapamycin, inhibitors of PDE4 or cyclooxygenase 2, anti-TNF therapy, exercise, and even psychological techniques targeting the sympathetic nervous system can have significant benefits in elderly persons. Moreover, antibiotic therapy may be beneficial in an adjuvant capacity to traditional medicine, radiotherapy, and surgery.

Societal Implications of an Aging Population

The implications of aging are not solely health-related. There are crosscutting issues and significant implications beyond care and medicine, as well as beyond its usual secondary risk for a catastrophic event such as a pandemic. In Europe, indeed, we prefer examining ""healthy aging"" from a broader, multidisciplinary, and intersectional perspective, taking into account policy, scientific, and forecasting measures and actions. In Japan and China, and in their academies, policy and societal implications of aging and longevity are especially addressed because East Asian Traditional Medicine merges and tries to integrate with these longer histories of aging medicine and technologies. All these principles apply to various and partially documented extents across Asia, Africa, the Americas, and Oceania.

Demographically, many countries are already in or are fast approaching aging. In addition to health implications, societal issues are just as challenging. It is, however, immediately unclear what the policy responses should be across these fields, both individually and collectively. Effective clinical support, health care, and compassionate, intergenerational care ensure that older adults can remain in or return to ""productive"" forms of contributing to society, and that they are not and do not feel cast adrift from it. In addition, researchers and policymakers must be concerned about the broader impacts of helping older people stay both healthy and engaged, across the broader aspects of any social care service: increased access and quality of health services, adapted national populations, labor markets, and public infrastructure, an aging-related increased personal capital, and investment in a broad sense of needed labor skills and expertise.

Healthcare Systems

Healthcare systems across the globe are struggling to balance changing demands associated with aging populations. As individuals live longer, they are more likely to develop chronic diseases requiring management over an extended interval. Older adults typically have more complex health concerns requiring a coordinated, multidisciplinary approach to care. They also stand to benefit the most from a focus on preventive healthcare and healthy lifestyle supports. Investment in geriatric-specific chronic disease management tailored to older adults will help alleviate the rising hospitalization rates. Given the increasing proportion of older adults, there is general agreement in most countries that geriatric care strategies should be integrated into primary healthcare, as geriatric syndromes are particularly dominant in this setting. Comprehensive geriatric assessment and care plans, along with interdisciplinary care teams centered on primary healthcare, are the preferred approaches. Increasingly, technology through the use of telehealth and electronic medical record systems is being used to enhance care efficiency and access.

Healthcare professional development in geriatrics and gerontology is imperative as these sectors continue to expand. Given present workforce realities, the need to develop the capacity of the current workforce is paramount. Educational opportunities at the student, resident, and health professional levels will provide future health professionals with the geriatric competencies upon graduation and more immediately expose them to the range of careers in aging. The aging of the population may have additional implications for specific populations, including the diversity of older adults, the elderly who are homeless, and frail elderly. In order to address the majority of the recommendations on the healthcare systems, improvements need to be made in policy. This will help ensure sustainable healthcare services for older adults and ensure access to healthcare services is equitable.

Overall, care must be more tightly integrated and comprehensive in providing tools to help people age well. Given the changing demographics, the care we provide must be better organized and developed, with older adults' needs and preferences at the forefront of policy recommendations. Older adults require the integrative approach provided in an interdisciplinary team setting. Specialty teams for older women have been found to be more effective than standard gynecological care. Specialty interdisciplinary teams for older home care clients have been shown to have better health outcomes. Creating focused geriatric teams for psychiatric care can lead to better health outcomes. Work needs to be done with respect to the development of health promotion and preventive activities for older adults, and basic healthcare for those who experience limited resources. As such, guideline development in each of these areas will lead to better health outcomes for older adults. It is also our recommendation that these guidelines be integrated across these areas, as older adults seeking healthcare typically have multiple chronic diseases. Thus, the chronic disease guidelines should be integrated to include the frail elderly.

Economic Impact

The importance of the aging trend has also been highlighted in many economic studies. An aging population brings the significant issue of increased old-age dependency, as the old-age support ratio (the ratio of those aged 65 and older to those aged 15 to 64) decreases in many economies, especially those that recently experienced high fertility decline. At the same time, however, some economies still have the opportunity to improve the share of the working-age population. In both the short term and the long term, the decreasing support ratio causes some challenges to respective countries' social security systems and public finances. From this point of view, economic policies should be adjusted to help each nation prepare for demographic transitions. One of the perspectives is the increase in labor force participation and the retirement age. On the other hand, the increase in the old-age population also creates opportunities. For years, consumers aged 60 and older have been interested in medical, health, nutrition, and well-being issues. Some economists regard 'elderly economics' as a potential emerging market. The growth of luxury spending on lifestyle and medical services has been intensively observed. This is not only because 'wealthy, experienced, more thoughtful/wisely', 'interests and hobbies are accompanied by money and dependency on consumption of high-end products'; for example, more seniors are willing to travel, so there is a growing demand for high-end services. Data also illustrate a sharp increase in spending on senior housing over the past decade, from a significant amount in 2011 to over a larger amount in 2019. A report also states that the global market for home care services is expected to grow to a substantial size by 2025. To capture these emerging economic issues, many countries have formulated aging-oriented policies, which formally involve those products and services associated with growing elderly demand. They also face significant uncertainties and risks. Even so, a growing number of public and private companies are focusing on investments and services associated with aging opportunities. At the macro level, the latest question is how the 'super-agers' economies will influence the global economy in the medium and longer term. The policy question is: how can we increase the labor force participation of the elderly as well as the effective and healthy retirement age, and maximize social value through the lifelong productivity of these people? Possible solutions require innovations in economy, management, and society.

Cultural Perspectives on Aging

The treatment of older people is not uniform within societies, let alone across the globe. When we valorize or devalue older people or specific experiences of aging, it is typically in the context of our own perspective, not inclusive of the many others that exist. In some cultures, older adults are revered as wisdom figures; in other societies, they are locked away in facilities or warehoused. Many cultures in the world are a combination of positive and negative views of aging. There are many ways that the treatment of older adults, as well as the aging experience, differs.

Many of these differences reflect cultural norms and circumstances, including community engagement, family structure, respective per capita wealth, historical experience, among other variables. Of course, these differences are blended so that, for example, not everyone in Italy has the same attitudes towards aging and older adults. However, when we discuss ""European"" or ""Western"" attitudes, we are oversimplifying by necessity to fully capture the range of expressions that can be found in these regions. Cultural perspectives about aging shape individual experience and expectations. Because of this, one part of Western culture discards the elderly, while older adults in some African and Asian cultures encourage younger people to view older people as a gift; aging represents an increase in social value within these societies. One's culture heavily influences the perceptions of aging and the judgments of those who are either old or close to it, even within cultures like those found in the United States and Europe, where there are diverse perspectives. Worldwide, aging is labeled as 'good' or 'bad', 'positive' or 'negative'. These perceptions and judgments not only shape the experience of aging but also help to form cultural values and beliefs.

Cultural views about aging are also shaped by historical narratives and cultural products. Given the increasing life expectancy of people in industrial, post-industrial, and developing countries, communicating positive images of aging in literature, film, television programs, and documentaries influences the self-perceptions of older people and is also used in educational and counseling efforts. Many theorists believe that being an older person is defined as the other. As the other, the chronological number carries with it a cultural and ethical load of associations. I believe the attachment to age has a greater impact on one's experience of life and the responsibilities one is asked to take up than does the actual age itself. When someone is treated negatively because of age, he or she is experiencing ageism. When put into practice, ageism is sometimes seen on an international level as a violation of human rights. Finally, some gerontologists have said that ideas surrounding age and aging might change because of an increase in globalization and immigration. These anonymous gerontologists feel that rather than being the ""other"" in society, international experience might start to make older people be seen as being the ""same"". Civilizations and traditions are coming together, especially through globalization, and the number of similar values concentrated in one area is increasing.

Attitudes towards Aging

Internationally, significant variations exist with respect to attitudes towards aging. While some societies hold the elderly in high esteem owing to their wisdom and contributions, others perceive aging as a process of gradual infirmity, mutability, and dependency. In the latter societies, stereotypical beliefs about aging play a powerfully influential role in shaping older individuals’ identity, personal behavior, and treatment by others. These stereotypes and myths include the portrayal of the elderly as frail, unproductive, and gloomy, with numerous illnesses, disabilities, and cognitive deterioration. Consequently, the older person comes to expect such deterioration to happen—effectively treating stereotypes as self-fulfilling prophecies—developing internalized negative attitudes and undermining their emotional, mental, and social health. Contrary to the myths, the majority of older adults enjoy physical mobility, intellectual soundness, emotional well-being, and social connectedness, and make numerous valuable contributions to society.

Empirical research tends to support a more positive view of aging. Older adults, as a group, are characterized by a great wealth of wisdom, experience, and historical and cultural insight. For societies struggling to cope with rapid technological and social changes, totaling in a rampant erosion of human values, this “living heritage” would provide invaluable direction and guidance. In many developing countries, traditions concerning aging continue to reflect an appreciation for those who have lived a long life and an understanding of aging as an important and valued life stage. The “generational divide,” so characteristic of many developed countries, is largely a function of the prevailing cultural and societal narrative. It is a historical “latecomer,” established as a result of materialistic and consumer-driven cultures of the 20th century, and since then perpetuated by a biased and negative storyline discharged mainly through mass media. Studies indicate that appreciative and supportive attitudes towards aging are associated with better mental and emotional health and relationships, acting as confounders for unfair treatment and victimization in later life. Encouraging and fostering positive attitudes and knowledge about aging require significant changes and overhauls in the societal narrative of aging. The provision of knowledge alone is unlikely to bear fruit unless buttressed by abundant opportunities to practice and observe the benefits of such knowledge in the broadest economic, social, and cultural environment.

Conclusion

As evident from this contribution, aging is a multifaceted topic. Although our experts come from wide-ranging disciplines, there are multiple points of convergence. We all argue that aging is a complex, dynamic, and non-unitary phenomenon that unfolds on several levels, spanning the cellular, personal, institutional, and policy dimensions. As such, we require dialogical, mutualistic, and multidisciplinary approaches to explore the manifold interconnectedness of the geriatric processes. We have to ask contributors with a bioscience angle how their research agenda has been shaped by the findings within the sociology and the politics of aging, and discuss further implications of such research on issues like the economics of aging. Presenting the opinions of different disciplines in group journals also has potential as a dialogue generator and can help in widening the circle of stakeholders in aging discussions. There are different service users of policy across these dimensions.

There is much to do that transcends our contribution here. For example, there is substantial work to do in critically assessing existing policy and clinical messages about aging, particularly those that are not based on scientific evidence. One policy area where our multidisciplinary approach is particularly applicable is public health. More good quality research is needed that measures the interplay of psychological, physiological, socioeconomic, and environmental variables on physical health in older populations. Politicians will demand models to predict the impact of policy change on population health that are able to cater for multiple determinants, and service users will demand services or public health messages based not just on age but also on solid scientific findings in geriatric, cellular, and policy studies. Looking beyond improving preventative public health care, there needs to be social and economic reforms to make the systems more age-friendly, such as introducing a tax model that recognizes income mixed with part-time work. There also needs to be changed attitudes toward older workers within the workplace and society in general. We require more good quality studies combining all areas of wellness in older adult populations. These would help us construct a truly holistic research and policy base for successful and healthy aging in older populations. Similarly, there are emerging studies demonstrating the potential role of technology in age-friendly living, and that such networking can be conducted via intergenerational links.

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