"Anti-aging" is an oxymoron

No intervention will slow, stop, or reverse the aging process in humans. Whether anti-aging medicine is, or is not, a legitimate science is completely dependent upon the definition of key terms that define the finitude of life: longevity determination, aging, and age-associated diseases. Only intervention in the latter by humans has been shown to affect life expectancy. When it becomes possible to slow, stop, or reverse the aging process in the simpler molecules that compose inanimate objects, such as machines, then that prospect may become tenable for the complex molecules that compose life forms. Most of the resources available under the rubric "aging research" are not used for that purpose at all, thus making the likelihood of intervention in the process even more remote. If age changes are the greatest risk factor for age-associated diseases (an almost universal belief), then why is the study of aging virtually neglected?     

Genetics of exceptional longevity

Centenarians exist at the extreme of life expectancy and are rare. A number of pedigree and molecular genetic studies indicate that a significant component of exceptional longevity is genetically influenced. Furthermore, the recent discovery of a genetic locus on chromosome 4 indicates the powerful potential of studying centenarians for genetic factors that significantly modulate aging and susceptibility to age-related diseases. These studies include siblings and children of centenarians. Siblings have a significantly increased propensity to achieve exceptional old age and have half the mortality risk of their birth cohort from young adulthood through extreme old age. The children of centenarians are emerging as a promising model for the genetic and phenotypic study of aging relatively slowly and the delay and perhaps escape of important age-related diseases.     

Blood group does not appear to affect longevity a pilot study in centenarians from Western Sicily

Centenarians are the best example of extreme human longevity, and they represent a selected population in which the appearance of major age-related diseases, such as cancer, and cardiovascular diseases among others, has been consistently delayed or escaped. The study of the long-lived individual genetic profile has the purpose to possibly identify the genes and the allelic variations influencing extended life expectancy, hence considering them as biomarkers of age-related diseases onset and development. The present study shows no significant differences between allelic variations of ABO blood groups among a group of centenarians from Western Sicily.     

Evolution of the needs of older persons

Most countries in the world experienced a major increase in life expectancy during the 20th century and a resulting aging of their populations. Further gains in life expectancy are uncertain, particularly in developed countries already characterized by a high longevity, and little is known concerning the health state of future generations of the elderly. But there is no doubt that further population aging will produce larger numbers of older persons both in developed and developing countries. As the prevalence of most chronic diseases is high in old age, population needs change rapidly in health care systems still organized essentially to provide acute care to children and young adults. Old age is heterogeneous, but a large proportion of older persons is affected by multiple chronic diseases, resulting in a wide range of needs. Health systems will have to adapt to this new situation while still providing appropriate responses to acute diseases affecting all ages. Although future needs are difficult to quantify, their nature is already apparent. Providing for these needs will require a major investment in manpower, a diversification of services delivered by health care systems, changes in the training of health professionals and extensive research to define effective treatments for elderly patients with multiple co-morbidities.     

Gender differences in health in Havana versus in Mexico City and in the US Hispanic population

Health progress in the 1960s and 1970s placed Cuba at the vanguard of longevity in Latin America and the Caribbean. This success has often been attributed to equity of access to the health care system and its cost-effectiveness in the country. Cuba also has a small gender gap in life expectancy. In this study, we examined how this pattern is reflected in the gender differences in health among the population aged 60+ in Havana. We compared gender differences in health in samples drawn from Havana, Mexico City, and the US Hispanic population: three geographic settings with very different political, health care, and social systems. The data come from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean and the 2000 Health and Retirement Study. Age-adjusted prevalence and logistic regressions were estimated for poor self-rated health, limitations on activities of daily living, depression, and mobility limitations. While an absolute female disadvantage in health was apparent in all three populations, the relative gender differences were inconsistent across all four health domains. Gender differences were most pronounced in Havana, even after adjusting for age, socio-economic status, family characteristics, and smoking behaviour. Despite having higher overall life expectancy and more equitable and universal access to primary care and preventive medicine, women in Havana appear to have a larger burden of ill health than women in less equitable societies. The study provides indirect evidence that Cuba faces challenges in combating the health threats posed by chronic diseases and other diseases and conditions common among the population aged 60+.Electronic supplementary materialThe online version of this article (10.1007/s10433-020-00563-w) contains supplementary material, which is available to authorized users.     

Implications of tobacco smoking on the oral health of older adults

Cigarette smoking is the foremost health risk issue affecting individuals of all age groups globally. It specifically influences the geriatric population as a result of chronic exposure to toxins. Its role in various systemic and oral diseases including cancer, premalignant lesions, periodontitis, tooth loss, dental caries and implant failures is well established. Smoking causes immuno‐inflammatory imbalances resulting in increased oxidative stress in the body. The latter hastens the immunosenescence and inflammaging process, which increases the susceptibility to infections. Thus, implementation of smoking cessation programs among older adults is imperative to prevent the development and progression of oral and systemic diseases. The present review focuses on smoking‐associated oral health problems in older adults, and the steps required for cessation of the habit. Geriatr Gerontol Int 2014; 14: 526–540. .     

Dietary effects on sex-specific health dynamics of medfly: support for the dynamic equilibrium model of aging

We examined experimentally the relationship between the period of unhealthy life and longevity in the medfly by using the first sign of supine behavior (upside down; immobile) in medflies as an indication of their poor health and by altering cohort longevity through dietary manipulations. Our main findings included the following: i) for longer lived medflies it was more likely to observe the supine behavior while shorter lived flies would more likely die before exhibiting the supine behavior. ii) males have similar total life expectancy as females but a longer healthy life expectancy; iii) the total number of healthy days, spent in the pre-supine period, and the amount of healthy life span as a fraction of the total lifespan varied with both sex and diet; iv) despite the large difference in longevity between both male and female medflies when reared on sugar-only diets versus on full diets, the differences in the fraction of their lifespans in the disabled state were relatively modest (64 vs 61% in females and 77 vs 72% in males). This finding that there is no significant change in the proportion of the life course in the unhealthy state is consistent with the ‘dynamic equilibrium’ model of healthy aging.     

Biology of aging. Current state of knowledge

The nature of the primary aging processes has yet to be defined. Mortality and aspects of longevity (eg, life expectancy) do not provide significant information about aging. The maximum life span potential of a species does provide information about the comparative rate of aging between species, however, and also is a good marker for evaluating interventions aimed at modulating the rate of aging in a particular species. Physiological deterioration occurs with age, but it is not known how much is due to aging per se and how much is secondary to age-related disease and life-style. There are similar reservations about the changes in body composition that have been noted with increasing age. Many diseases are age related in terms of prevalence, but how these diseases relate to the primary aging processes remains to be defined. Finally, many claims have been made concerning interventions that will retard the aging processes; of these, only food restriction in rodents has been unequivocally shown to retard the aging processes of a mammalian species.     

Erkenntnisse zur Verlängerung behinderungsfreier Lebenszeit

The relationship between quality of life and aging is difficult to describe with the usual epidemiological concepts like mortality. A functional approach is more important and meaningful for the analysis of the aging process. The ICIDH classification has the advantage of combining the diseases process itself and the consequences concerning functional limitations. Studies about the "active life expectancy" show that quality of life and life expectancy are two different dimensions of the aging process. For the purpose of prevention, it is important to demonstrate that preventive interventions could help reduce the number of years with functional limitations. Most of the epidemiological studies indicate that even lost functions could be restored. For these interventions, it is important to individualize the goals for preventive measures to balance physical and emotional needs of the elderly.     

Is there an antiaging medicine?

In spite of considerable hype to the contrary, there is no convincing evidence that currently existing so-called "antiaging" remedies promoted by a variety of companies and other organizations can slow aging or increase longevity in humans. Nevertheless, a variety of experiments with laboratory animals indicate that aging rates and life expectancy can be altered. Research going back to the 1930s has shown that caloric restriction (also called dietary restriction) extends life expectancy by 30-40% in experimental animals, presumably at least partially by delaying the occurrence of age-dependent diseases. Mutations that decrease production of insulin growth factor I in laboratory mammals, and those that decrease insulin-like signaling in nematodes and fruit flies, have increased life expectancy as well. Other general strategies that appear promising include interventions that reduce oxidative stress and/or increase resistance to stress; hormone and cell replacement therapies may also have value in dealing with specific age-related pathologies. This article reports the findings of a consensus workshop that discussed what is known about existing and future interventions to slow, stop, or reverse aging in animals, and how these might be applied to humans through future research.     

Effects of rapid smoking on post-cessation urges to smoke

CONTEXT: Rapid smoking (RS) is a smoking cessation technique with sufficient indications of promise to warrant further investigation. The main presumed effect of RS is on reducing desire to smoke. AIM: To evaluate the effect of a single session of RS immediately prior to quitting smoking on urges to smoke over the first week of abstinence. DESIGN: Randomized controlled trial. SETTING: Specialist smoking cessation clinic (SSCC). PARTICIPANTS: A total of 100 smokers attending the quit day session. INTERVENTION: Participants in the rapid smoking group underwent a single session of RS immediately prior to quitting smoking. Participants in the control group watched a health promotion video on giving up smoking. PRIMARY OUTCOME MEASURES: Ratings of urges to smoke in the first 24 hours and 1 week of abstinence. FINDINGS: The RS procedure was well tolerated. It led to significantly lower urges to smoke compared to the control procedure during the first 24 hours (mean rating of 2.6 versus 3.2, P < 0.001) and the first week of abstinence (1.8 versus 2.5, P < 0.01). In patients abstinent for 4 weeks, urges to smoke were low and the difference was no longer significant (1.4 versus 1.8). CONCLUSION: RS has an 'active ingredient' (craving reduction) and its effects on smoking cessation may merit further examination using modern rigorous methodology.     

Benefits of smoking cessation with focus on cardiovascular and respiratory comorbidities

Smoking cessation is crucial in preventing premature morbidity, disability and mortality worldwide. The effectiveness of quitting tobacco use surpasses any other intervention to minimise the risk for chronic cardiac and respiratory conditions. The overall health benefits of smoking cessation have been recognised for decades but as tobacco legislation has been changing in recent years, new evidence particularly concerning the effect of less smoke exposure on the vascular system has emerged. Recently, much research in chronic obstructive pulmonary disease (COPD) has concerned the ongoing inflammation - also in former smokers - and disease heterogeneity, which provides new knowledge regarding current and ex-smokers with COPD. Many other cardiovascular and respiratory diseases are associated with smoking, and the course of these diseases is not always studied in the context of smoking cessation versus continued smoking. This review summarises the latest available data on health benefits of smoking cessation with focus on both common and infrequent cardiovascular and respiratory diseases.     

Does the reaction of abstaining smokers to the smell of other people's cigarettes predict relapse?

Aims Recent ex‐smokers report a range of reactions to other people's cigarette smoke. We examined the hypothesis that those who find the smell of smoke pleasant and tempting are more likely to relapse than those who have a neutral or even negative reaction to it. Design A total of 1110 consecutive patients who attended for smoking cessation treatment and achieved at least 1 week of validated abstinence provided weekly ratings of their reactions to other people's cigarette smoke together with routine baseline measures and weekly ratings of withdrawal discomfort [measured on the Mood and Physical Symptom Scale (MPPS)]. Findings Twenty‐three per cent of the sample found the smell of other people's cigarette smoke during their first week of abstinence pleasant, and 54% found it tempting. There was only a modest correlation between the two variables. Finding the smoke pleasant was not related to smoking status in the following week, but finding the smoke tempting predicted relapse. Ratings of temptation were related to the severity of withdrawal discomfort and to dependence. Entering MPPS ratings of urges to smoke in the given week into regression analysis resulted in the general urges to smoke, rather than urges elicited by other people's smoke, becoming a significant predictor of smoking status in the following week. In patients who maintained continuous abstinence throughout 4 weeks of treatment the pleasantness ratings remained stable, while the ratings of temptation steadily decreased. Conclusions In abstaining smokers, the like or dislike of other people's smoke is not related to relapse. The temptation to smoke elicited by other people's smoke is related to outcome, but only as an indicator of a general ‘temptation threshold’. Patients who find other people's smoke tempting can be reassured that this reaction will gradually decrease.     

Tobacco use disorder and the lungs

This narrative review provides a summary of the impact of tobacco smoking on the respiratory system and the benefits of smoking cessation. Tobacco smoking is one of the leading preventable causes of death world-wide and a major risk factor for lung cancer and chronic obstructive pulmonary disease. Smoking is also associated with an increased risk of respiratory infections and appears to be related to poorer outcomes among those with COVID-19. Non-smokers with second-hand smoke exposure also experience significant adverse respiratory effects. Smoking imposes enormous health- and non-health-related costs to societies. The benefits of smoking cessation, in both prevention and management of respiratory disease, have been known for decades and, to this day, cessation support remains one of the most important cost-effective interventions that health professionals can provide to people who smoke. Cessation at any age confers substantial health benefits, even in smokers with established morbidities. As other treatments for chronic respiratory disease advance and survival rates increase, smoking cessation treatment will become even more relevant. While smoking cessation interventions are available, the offer of these by clinicians and uptake by patients remain limited.     

Physiological requirements for longevity

Genetic background is an important factor for longevity. Life-style and environmental factors, such as nutrition, physical activity, smoking and alcohol, are also important. For example, obesity is negatively associated with health and longevity. It is known that dietary restriction is the most consistent method of extending life span in rats. In human, however, under nutrition as well as over nutrition is a risk factor for a short life. Losing weight is often dangerous in the elderly, in whom reserved physiological functions are limited. Smoking, diabetes mellitus and hypertension accelerate human aging, while physical activity and a moderate amount of alcohol is good to live long. Preventive medicine and health support are also important to promote longevity. Good results of new strategies such as custom-made health support and preventive treatment are anticipated in the near future. Accumulation of basic data in human aging and health are essential to the practice of preventive medicine and health support. A new comprehensive longitudinal study was started at the National Institute of Longevity Sciences (NILS) in 1997 (NILS-Longitudinal Study of Aging, NILS-LSA). The results of this study should be helpful for the practice of preventive medicine and health support.     

Occurrence of chronic diseases and their impact on physical disability over the whole spectrum of aging: from 65 to over 100 years of age

Summary The aging of the Italian population is an emerging public health priority. In 2025 Italy is expected to have the highest world median age with nearly half of the population over 50 years old. To avoid an unbearable burden of disease and disability on future generations, we must identify areas for intensive disease and disability prevention programs. Preliminary results from the PRO.V.A study show that disability is associated with conditions that are potentially preventable as chronic diseases and falls or are treatable as chronic pains. Moreover, it is of extreme interest to identify and understand biological and environmental secrets of successful aging as the AKEA study tries to do and the ways of overcoming disabilities in the extreme limits of life more and more possible to reach. Received: 10 July 1999, Accepted: 30 August 1999     

The genetics of exceptional human longevity

There is a substantial distinction to be made between the genetics of aging and the genetics of exceptional longevity. Twin studies suggest that the average set of genetic variations facilitates the average human's ability to live well into their octogenarian years. Other studies indicate that taking full advantage of this average set results in spending the majority of those years in good health. However, many people counteract such genetic endowment with poor health habits, resulting in a substantially lower average life expectancy and relatively more time spent in poor health. To live beyond the octogenarian years, life-span experiments in lower organisms and mammals and population and molecular genetic studies of centenarian sibships suggest that genetic factors play an important role in exceptional longevity. These factors are likely to influence basic mechanisms of aging, which in turn broadly influence susceptibility to age-related illnesses. Lacking genetic variations that predispose to disease, and having variations that confer disease resistance (longevity enabling genes), are probably both important to such a remarkable survival advantage. Recent studies indicate the likelihood that such factors will be elucidated in the near future.     

Looking forward to a general theory on population aging

The main theories on population aging based on recent data on human longevity, life expectancy, morbidity changes, disability trends, and mortality decrease are presented and discussed within their own geographic, cultural, socioeconomic, and medical contexts. The complex interactions between all these components do not facilitate trend forecasting of aging population (healthy aging versus disability pandemic). In the context of population aging, four elements were introduced with their implications: 1) an increase in the survival rates of sick persons, which would explain the expansion of morbidity, 2) a control of the progression of chronic diseases, which would explain a subtle equilibrium between the decrease in mortality and the increase in disability, 3) an improvement of the health status and health behaviors of new cohorts of elderly people, which would explain the compression of morbidity, and eventually 4) an emergence of very old and frail populations, which would explain a new expansion of morbidity. Obviously, all these elements coexist today, and future trend scenarios-expansion or compression of disability-depend on their respective weights leading to the need of elaborating "a general theory on population aging." This theory has to be based on a world harmonization of functional decline measurements and a periodic "International Aging Survey" to monitor global aging through a sample of carefully selected countries.     

Cigarette smoke – an aging accelerator?

Cigarette smoking reduces life span by an average of 7 years, and tobacco consumption accounts for a shortening of disease free life by 14 years. The exact mechanisms by which smoking causes disease and death are generally not well understood, but evidence continues to mount that cigarette smoking exhausts cellular defense and repair functions, leading to an accumulation of damage e.g. mutations and malfunctioning proteins. In this review, we make an attempt to ascribe many of the deleterious effects of smoking on human health to a general principle, namely the acceleration of aging processes by cigarette smoke chemicals.