Changes in views on aging in later adulthood: the role of cardiovascular events

A number of longitudinal studies have pointed to the long-term impact of different views on aging (VoA) on health in later life, whereas the reverse relationship has rarely been examined. Serious cardiovascular events such as myocardial infarction or stroke are life-threatening events which might in turn lead to changes in VoA. The present longitudinal study examined the effect of a cardiovascular event (CVE) on VoA over a three-year period using pooled data from three waves of the German Ageing Survey (2008, 2011, 2014, age range: 40–95 years). In order to account for alternative explanations for changes in VoA, individuals without CVE (n = 200) were matched to individuals who experienced a CVE (n = 202) using a propensity score matching procedure. Compared to individuals without CVE, individuals who experienced a CVE showed adverse changes in three VoA indicators (self-perceptions of aging as associated with physical losses/with ongoing development; subjective age). These results suggest that CVE can in fact change how individuals view their own aging. According to previous studies, this can lead to future health changes and thus become a health-related downward spiral. Health promotion programs could, therefore, profit by adding specific VoA interventions for individuals who experienced a CVE.     

The assessment of views on ageing: a review of self-report measures and innovative extensions

This is a review of existing self-report measures for assessing views on ageing. It provides an overview of instruments, for which basic psychometric properties are available and describes them according to the purposes for which they are suitable. Literature search resulted in the inclusion of 89 instruments which were categorised along eight dimensions. The majority of measures focus on explicit cognitions about people’s own age and ageing or other (older) people. A substantial amount of tools account for the multidimensionality and multidirectionality of views on ageing, i.e. the idea that ageing is accompanied by both gains and losses in several different domains. To some extent, measures reflect that ageing is a long-term process and that views on ageing are malleable, rather than just stable traits. Cluster analysis revealed heterogeneity in instruments regarding the dimensions of Ecosystem, Balance, Stability, Dynamics, and Complexity. It becomes apparent, however, that approaches to measure views on ageing should be extended to more specifically target the implicit level as well as affective, physiological, and behavioural manifestations. Additionally, means for capturing views on ageing on the societal level and tools with a distinct time reference are needed. This is particularly important when one wants to account for the lifelong dynamics of views on ageing.     

The role of mitochondrial DNA mutations and free radicals in disease and ageing

Considerable efforts have been made to understand the role of oxidative stress in age‐related diseases and ageing. The mitochondrial free radical theory of ageing, which proposes that damage to mitochondrial DNA (mtDNA) and other macromolecules caused by the production of reactive oxygen species (ROS) during cellular respiration drives ageing, has for a long time been the central hypothesis in the field. However, in contrast with this theory, evidence from an increasing number of experimental studies has suggested that mtDNA mutations may be generated by replication errors rather than by accumulated oxidative damage. Furthermore, interventions to modulate ROS levels in humans and animal models have not produced consistent results in terms of delaying disease progression and extending lifespan. A number of recent experimental findings strongly question the mitochondrial free radical theory of ageing, leading to the emergence of new theories of how age‐associated mitochondrial dysfunction may lead to ageing. These new hypotheses are mainly based on the underlying notion that, despite their deleterious role, ROS are essential signalling molecules that mediate stress responses in general and the stress response to age‐dependent damage in particular. This novel view of ROS roles has a clear impact on the interpretation of studies in which antioxidants have been used to treat human age‐related diseases commonly linked to oxidative stress.     

The genetics of ageing: insight from genome-wide approaches in invertebrate model organisms

Intense effort has been directed at understanding pathways modulating ageing in invertebrate model organisms. Prior to this decade, several longevity genes had been identified in flies, worms and yeast. More recently, with the development of RNAi libraries in worms and the yeast open reading frame (ORF) deletion collection, it has become routine to perform genome-wide screens for phenotypes of interest. A number of worm screens have now been performed to identify genes whose reduced expression leads to longer lifespan, and two ORF deletion longevity screens have been performed in yeast. Interestingly, these screens have linked previously unidentified cellular pathways to invertebrate ageing. More surprising, however, is the sheer number of longevity genes in worms and yeast. In this review, I discuss data from genome-wide screens in the context of evolutionary theories of ageing and raise issues regarding the increasing complexity associated with the genetics of longevity.     

SIRT6 in DNA repair, metabolism and ageing

Ageing, or increased mortality with time, coupled with physiologic decline, is a nearly universal yet poorly understood biological phenomenon. Studies in model organisms suggest that two conserved pathways modulate longevity: DNA damage repair and Insulin/Igf1-like signalling. In addition, homologs of yeast Sir2--the sirtuins--regulate lifespan in diverse organisms. Here, we focus on one particular sirtuin, SIRT6. Mice lacking SIRT6 develop a degenerative disorder that in some respects mimics models of accelerated ageing [Cell (2006) 124:315]. We discuss how sirtuins in general and SIRT6 specifically relate to other evolutionarily conserved pathways affecting ageing, and how SIRT6 might function to ensure organismal homeostasis and normal lifespan.     

Strong and weak lifespan extension: what is most feasible and likely?

Recent advances in biomedical science indicate that it may eventually be possible to intervene in the biological process of human ageing. This paper overviews the current state of the science of lifespan extension and promising future directions. It is uncertain whether ‘strong’ lifespan extension – the extension of human life beyond the maximum 122 years so far observed – will become a reality. It is more likely that cumulative effects of numerous scientific and biomedical advances in the treatment of common disease will produce ‘weak’ lifespan extension – the extension of average life expectancy. The practical application of molecular, genetic and nanomaterials research may also lead to advances in life expectancy. It is not too early to begin to consider the policy implications of either form of lifespan extension.     

Childhood adversity and healthy ageing: a study of the Chinese older population

This study examines the relationship between childhood adversities and healthy ageing in the Chinese older population. The data come from the China Health and Retirement Longitudinal Survey (CHARLS), a national survey that collected life history and ageing-related information on 9248 older people aged over 60 in 2014 and 2015. The analysis of healthy ageing focuses on seven indicators: IADL limitations, ADL limitations, cognitive functioning, depressive symptoms, life satisfaction, self-reported health, and chronic illness. Using k-means clustering, an unsupervised learning technique, we identified four qualitatively different groups according to their achievement in healthy ageing. We studied 17 types of childhood adversities and found that experiencing multiple childhood adversities is associated with a lower probability of achieving healthy ageing. This relationship is moderated by age and gender. Women are more vulnerable than men to the negative impacts of childhood adversities. The threat of childhood adversities to healthy ageing is greatly attenuated among people aged over 80. We argue that the policy response to healthy ageing should not be confined to those services and programmes that directly target older people. Instead, healthy ageing can be better addressed by concerted efforts in different areas of social policy.     

Ageing, genes, environment and epigenetics: what twin studies tell us now, and in the future

Compared with younger people, older people are much more variable in their organ function, and these large individual differences contribute to the complexity of geriatric medicine. What determines this variability? Is it due to the accumulation of different life experiences, or because of the variation in the genes we are born with, or an interaction of both? This paper reviews key findings from ageing twin cohorts probing these questions. Twin studies are the perfect natural experiment to dissect out genes and life experiences. We discuss the paradox that ageing is strongly determined by heritable factors (an influence that often gets stronger with time), yet longevity and lifespan seem not to be so heritable. We then focus on the intriguing question of why DNA sequence-identical twins might age differently. Animal studies are increasingly showing that epigenetic modifications occurring in early development and adulthood, might be key to ageing phenomena but this is difficult to investigate longitudinally in human populations, due to ethical problems of intervention and long lifespan. We propose that identical twin studies using new and existing cohorts may be useful human models in which to investigate the interaction between the environment and genetics, mediated by epigenetic modifications.     

The uniqueness of subjective ageing: convergent and discriminant validity

Although a large body of research has demonstrated the predictive power of subjective ageing for several decisive developmental outcomes, there remains some controversy about whether subjective ageing truly represents a unique construct. Thus, information about the convergent and discriminant validity of different approaches to measuring subjective ageing is still critically needed. Using data from the 2014 wave of the German Ageing Survey, we examined how three established subjective ageing measures (subjective age, global attitude toward own ageing, multidimensional ageing-related cognitions) were inter-related as well as distinct from general dispositions (optimism, self-efficacy) and well-being (negative affect, depressive symptoms, self-rated health). Using correlational and multivariate regression analysis, we found that the three subjective ageing measures were significantly inter-related (r = |.09| to |.30|), and that each measure was distinct from general dispositions and well-being. The overlap with dispositional and well-being measures was lowest for subjective age and highest for global attitudes towards own ageing. The correlation between global attitudes towards own ageing and optimism was particularly striking. Despite the high convergent validity of the different dimensions of ageing cognitions, we nevertheless observed stronger associations between specific dimensions of ageing cognitions with negative affect and self-rated health. We conclude that researchers should be aware of the multidimensional nature of subjective ageing. Furthermore, subjective age appears to be a highly aggregated construct and future work is needed to clarify its correlates and reference points.Electronic supplementary materialThe online version of this article (10.1007/s10433-019-00529-7) contains supplementary material, which is available to authorized users.     

The power of personality in successful ageing: a comprehensive review of larger quantitative studies

In this paper, we highlighted links between personality traits and successful ageing through a systematic review of recent empirical studies. Particularly, we addressed the question of whether personality traits are related to successful ageing and, if so, why and how? Answers to this question provided, for example, arguments that supported personality’s role in planning an individual’s future based on self-knowledge, thereby contributing to a sense of identity throughout their life. Then, considering longitudinal studies, we examined whether personality is stable over one’s life course, or does it change and, if so, why and under what conditions? Answers to this question gave substance to the idea that a stable personality allows for continuous and consistent development. In addition, certain personality changes are likely to allow an individual to develop the resilience to better adapt to life’s challenges. Therefore, the arguments brought by these two questions can help clarify the modulating role of personality for successful ageing via health and well-being outcomes. These insights may contribute to the development of new prevention approaches, more focused on inter- and intraindividual differences, to promote successful ageing.     

Successful ageing in the oldest old: objectively and subjectively measured evidence from a population-based survey in Germany

Despite rapid increase of people aged 80 and over, concepts of successful ageing (SA) are primarily examined for people below that age. Therefore, successful ageing was examined in a population-based representative sample of N = 1863 people aged 80 to 102 (NRW80+) with 11% living in institutionalized settings. In this survey on quality of life and well-being, multiple linear and logistic regression models were used to calculate the distribution of successful agers. According to Rowe and Kahn’s objective definition, 9% of the sample aged successfully, but one-third (33%) still met four to five SA criteria. This is in line with the theoretical a priori criterion of 10% in a normal distribution of a sample, while 80% age normally and 10% pathologically. However, averages of life satisfaction, affective well-being, positive ageing experience and valuation of life were high. The majority of the oldest old (65%) are successful agers in their own subjective perception, which is not in line with objective measurements. Moreover, 11% of objectively measured successful agers do not meet subjective criteria. These empirical findings reveal a remarkable discrepancy between objective and subjective criteria of SA. Future research on concepts that define successful ageing for the oldest old should consider more holistic markers of success, e.g., outcomes of productive social engagement.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-021-00609-7.     

AIDSImpact special issue – broadening the lens: recommendations from rehabilitation in chronic disease to advance healthy ageing with HIV

ABSTRACT

People living with HIV are ageing with a combination of physical, mental and social health challenges, known as disability. Although rehabilitation can address disability, the field is still emerging. Our aim was to identify similar disability experiences across complex chronic conditions and establish recommendations for future rehabilitation research and practice to advance healthy ageing with HIV. We conducted a consultation with 77 stakeholders from the United Kingdom, Canada, and Ireland with expertise in the fields of rehabilitation and HIV, cancer, cardiovascular disease, renal disease, or chronic obstructive pulmonary disease who attended a one-day symposium. We used facilitated discussions to identify how rehabilitation issues in complex chronic disease translate to people ageing with HIV, and prioritised recommendations for future practice and research. Disability issues experienced across HIV and other complex chronic diseases included: (i) frailty, (ii) uncertainty and worrying about the future ageing with complex chronic disease, (iii) mental health, (iv) pain, and (v) stigma. We highlight six recommendations for clinical practice and research to advance healthy ageing with HIV. Opportunities for cross-collaboration exist with other more established areas of chronic disease management and rehabilitation. Recommendations can be used to inform future HIV clinical practice and research in this emerging field.     

Comparative ageing research: a flourishing field in need of theoretical cultivation

Comparative ageing research is a flourishing field, partly because of European funding in this area. Comparing different societies and cultures seems especially fruitful for the analysis of societal and cultural factors in development over the life course. From a nomothetic perspective, the aim of comparisons is the search for similarities and communalities in different societies and cultures; from an idiographic perspective, researchers are looking for societal and cultural specificity and distinctiveness. However, the potentials of comparative ageing research are not fully realized for the time being. In many cases, there is little theorizing as to whether there should be differences (or similarities) in ageing processes across countries, societies, or cultures. This paper discusses theoretical aims and ambitions of comparative ageing research in general. Comparative theories are sketched which could serve as a basis for comparative ageing research, and ageing theories are discussed which could be modified to be used in comparative research. The rationale of comparative ageing research is described and illustrated through empirical examples. Epistemological and methodological pitfalls (problems of conceptual, operational, functional, and measurement equivalence) are a substantial obstacle to comparative ageing research. Hence, merits and limitations of comparative designs and sampling procedures are considered.     

Predicting survival and morbidity-free survival to very old age

As life expectancy continually increases, it is imperative to identify determinants of survival to the extreme end of the lifespan and more importantly to identify factors that increase the chance of survival free of major morbidities. As such, the current study assessed 45 common disease factors as predictors of survival and morbidity-free survival to age 85 years. Within the Rotterdam Study, a population-based cohort, we evaluated morbidity-free participants who were able to attain age 85 within the study duration (n = 2,008). Risk factors were assessed at baseline (1990–1993), and mortality and morbidities were then collected continuously until mortality or the occurrence of their 85th birthday (average time of 7.9 years). Risk factors included demographic and lifestyle variables, health and morbidity indicators and physiological makers. Major morbidities examined included dementia, cancer, cerebrovascular accident, heart failure and myocardial infarction. Logistic regression analyses demonstrated that many of the variables were independently predictive for survival and for morbidity-free ageing to 85 years. These included being female, absence of left ventricular abnormalities, stable body weight, unimpaired instrumental activities of daily living, lower C-RP levels and higher levels of femoral neck bone mineral density and albumin. Relative to non-survival, predictors were stronger for morbidity-free survival than for total survival or survival with morbidity. This suggests that lifespan and healthy survival to older age can be relatively well predicted. Understanding predictors of a long and healthy lifespan is vital for developing primary and secondary preventions to help improve the quality of life of older adults and for reducing the financial burden of the rapidly escalating ageing population.     

Assessing the role of stress signalling via p38 MAP kinase in the premature senescence of Ataxia Telangiectasia and Werner syndrome fibroblasts

The premature ageing Ataxia Telangiectasia (AT) and Werner syndromes (WS) are associated with accelerated cellular ageing. Young WS fibroblasts have an aged appearance and activated p38 MAP kinase, and treatment with the p38 inhibitor SB230580 extends their lifespan to within the normal range. SB203580 also extends the replicative lifespan of normal adult dermal fibroblasts, however, the effect is much reduced when compared to WS cells, suggesting that WS fibroblasts undergo a form of stress-induced premature senescence (SIPS). A small lifespan extension is seen in AT cells, which is not significant compared to normal fibroblasts, and the majority of young AT cells do not have an aged appearance and lack p38 activation, suggesting that the premature ageing does not result from SIPS. The lack of p38 activation is supported by the clinical manifestation, since AT is not associated with inflammatory disease, whereas WS individuals are predisposed to atherosclerosis, type II diabetes and osteoporosis, conditions known to be associated with p38 activation.     

Longevity and the stress response in Drosophila

The concept that lifespan is a function of the capacity to withstand extrinsic stress is very old. In concordance with this, long-lived individuals often have increased resistance against a variety of stresses throughout life. Genes underlying the stress response may therefore have the ability to affect lifespan. The progress in modern genetic techniques has allowed researchers to test this idea. The general stress response involves the expression of stress proteins, such as chaperones and antioxidative proteins, downregulation of genes involved in energy metabolism and the release of protective substances. Do these same changes in patterns of expression have the ability to mitigate ageing and prolong lifespan? It appears that parts of this response indeed are also associated with extended longevity, whereas some elements are not, due to their high cost or long-term deleterious consequences. Here we briefly review the state of the art of research on ageing and longevity in the model organism Drosophila, with focus on the role of the general stress response. We will conclude by contemplating some of the implications of the findings in this research and will suggest several directions for future research.     

Confronting ageism: The potential of intergenerational contemporary art events to increase understandings of older adults and ageing

Objective

To explore the impact of an innovative intergenerational art event showcasing retirement village life on attendees’ understandings of older adults and ageing.

Methods

A survey of 93 art event attendees was conducted immediately after 16 sessions of the event (78% response rate). Respondents reported on their event experience and its impact on their understandings of older adults and attitudes towards ageing. Analysis of Variance (ANOVA) used to test for differences between age groups (18–34, 35–64 and 65+ years).

Results

Over 90% of attendees reported the art event helped them develop an understanding of the lives of older people, with the greatest impact on young and middle‐aged adults. The majority of young and middle‐aged adults, however, expressed concern about their own ageing.

Conclusion

Results suggest that intergenerational art events have the potential to increase understandings of older adults and their lives, but this may not translate into personalised comfort with ageing.     

Contribution of Lifestyle to Positive Ageing in Hong Kong

The Objective of this study is to examine the knowledge, use, and development of a healthy lifestyle, and the association with positive ageing, in a convenient sample of 2,970 community-living Hong Kong Chinese People aged 40–74 years stratified by age. A questionnaire containing items from these three domains (avoidance of disease, physical and cognitive functioning, engagement with life) was administered from which a positive ageing index was calculated. A lifestyle score was calculated from information regarding current knowledge, use, and development of a healthy lifestyle (relating to diet, exercise rest and relaxation, smoking habit and alcohol use). The association between lifestyle score and the positive ageing index was weaker compared with income and education level. We conclude that knowledge, use and development of a healthy lifestyle did not contribute greatly to the positive ageing process.

What does the community think about lifespan extension technologies? The need for an empirical base for ethical and policy debates

Objectives: This paper examines public understandings of possibilities for increasing life expectancy, interest in taking up lifespan‐extending interventions, and motivations influencing these intentions. Methods: Structured interviews were conducted with 31 adults, aged 50 and over. Results: Participants believed that technological advances would increase life expectancy but questioned the value of quantity over quality of life. Life in itself was not considered valuable without the ability to put it to good use. Participants would not use technologies to extend their own lifespan unless the result would also enhance their health. Conclusions: These findings may not be generalisable to the general public but they provide the first empirical evidence on the plausibility of common assumptions about public interest in ‘anti‐ageing’ interventions. Surveys of the views of representative samples of the population are needed to inform the development of a research agenda on the ethical, legal and social implications of lifespan extension.     

A research framework for the United Nations Decade of Healthy Ageing (2021–2030)

The mission of UN Decade of Healthy Ageing (2020–2030) is to improve the lives of older people, their families and their communities. In this paper, we create a conceptual framework and research agenda for researchers to knowledge to address the Decade action items. The framework builds on the main components of healthy ageing: Environments (highlighting society and community) across life courses (of work and family) toward wellbeing (of individuals, family members and communities). Knowledge gaps are identified within each area as priority research actions. Within societal environments, interrogating beliefs about ageism and about familism are proposed as a way to illustrate how macro approaches to older people influence their experiences. We need to interrogate the extent to which communities are good places to grow old; and whether they have sufficient resources to be supportive to older residents. Further articulation of trajectories and turning points across the full span of work and of family life courses is proposed to better understand their diversities and the extent to which they lead to adequate financial and social resources in later life. Components of wellbeing are proposed to monitor improvement in the lives of older people, their families and communities. Researcher priorities can be informed by regional and national strategies reflecting Decade actions.