Ageing: What is the process? And can we reverse it? – Sydney Morning Herald

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Its a fact that many of us dont want to face: with every tick of the clock, every one of us is ageing. It feels scary. But it neednt.

Being human and living our lives is all about change, and thats what ageing is, its change over time, says Professor Julie Byles, a social gerontologist and researcher at Newcastle University.

Ageing is intrinsic to the living species on this planet but how we grow old, and the factors that influence the process, are complex and unpredictable.

Credit:Illustration: Dionne Gain

Ageing is universal but not uniform: its universal because it happens in all cells and all species, but its not uniform in that we dont all go through it in the same way, Professor Byles says.

Australia has one of the highest life expectancies, ranking ninth among OECD countries behind Switzerland, Iceland, Italy, Norway, Japan, Sweden, Israel and Spain.

An Australian born in 2019 can expect to live to about 83, some 34 years longer than people born in the 1880s (in Japan, the average age expectancy is just over 84). Today, about one in seven Australians are 65 or older. By 2057, itll be almost one in four.

As the World Health Organisation says, with good health a longer life brings opportunities: to pursue new activities, a long-neglected passion or even a fresh career.

We may feel more empowered to make those extra years as fulfilling and meaningful as possible if we understand how ageing happens that its a lifelong process, not just some switch that gets flicked in your 60s, says Peter Lange, a University of Melbourne clinical associate professor in geriatrics. There is a lot of nihilism about ageing and a lot of people think that disease is inevitable; that theyll go into a nursing home or develop dementia. Thats not true but, by believing its going to be the case, they end up failing to take action to prevent it, he says.

Can we slow ageing? How does it happen? And how can ageism be a form of self-sabotage?

While most people dont start feeling the effects until at least their 30s, the seeds of ageing start when we do.

Its happening all your life. It starts even before youre born, from the very first cell division, says Byles. Thats because ageing comes down to a gradual accumulation of problems, starting with tiny DNA transcription errors from the very beginning.

Our cognitive processes peak about the time were 20. In fact, most of our bodys systems are thought to peak when we are between 18 and 30, says Leon Flicker, a professor of geriatric medicine at the University of Western Australia. That seems to be when the ageing process ... starts kicking in, and you have a progressive decline, Flicker says.

Ageing is not programmed, though. As we move through the world, we suffer little bits of damage it could be from sunlight, bacteria, a sprained ankle, a shonky DNA copy, bad food that the body then works to repair.

Its happening throughout every second of our existence, says Flicker.

But over time our physiological reserves drop, so were left accumulating damage that our body gradually cant keep up with fixing and this can manifest in all sorts of ways.

The thing about ageing is its affecting every system of the body and different parts get impacted differently. No two 80-year-olds will be the same.

The changes we experience as we age are neither linear nor consistent, and there is an extraordinary level of variability among older people.

The thing about ageing is its affecting every system of the body and different parts get impacted differently. No two 80-year-olds will be the same, says Dr Kate Gregorevic, Royal Melbourne Hospital geriatrician and author of Staying Alive: The Science of Living Healthier, Happier and Longer.

There are certain hallmarks of ageing on a molecular and cellular level. For example, Gregorevic says, we collect damage in our DNA. One way is that each time our cells divide, the little protective caps on the ends of our chromosomes, called telomeres which are often likened to the plastic tips on shoelaces gradually shorten, which affects our ability to copy DNA properly.

When DNA is damaged, over time more cells can die or become cancerous. More cells also become whats called senescent they stop dividing. On the one hand, this defends against cancer but these senescent cells also take up space without contributing, causing inflammation and overstimulating the immune system, which cant keep up with removing them.

Then there are the changes we often notice from our 40s, says Lange: skin loses elasticity; hair turns grey as pigment cells in our follicles slowly die; we become long-sighted as the lenses of our eyes stiffen; in some people, hearing dulls.

Muscle loss, or sarcopenia, is another typical part of ageing. One study observed that muscle mass decreased between about 3 and 8 per cent each decade after age 30 and the rate of decline was higher after 60. We know that with age we can lose muscle strength, Gregorevic says, particularly, we lose fast-twitch muscle fibres theyre the ones you use when sprinting or when you catch your foot on the pavement and need to steady yourself fast.

At the same time, bone density drops while ligaments and joints stiffen, becoming more at risk of injury, and taking longer to heal. Also common are weakening lungs. Our cardiovascular system is impacted, and there are certain hormonal changes, with people exposed to a higher level of cortisol (the stress hormone) as they age.

The pile-up of all these changes gradually increases our vulnerability to disease or insults such as a seemingly minor fall leading to bone fracture and eventually leads to frailty, which is a loss of physical reserve that affects almost everybody by their 90s.

If youre frail, says Gregorevic, your body is already working so hard at the best of times just to get through daily life. So, when you get a cold it takes all your energy.

But its not all bad news.

Credit:Illustration: Dionne Gain

Theres a lot of confusion between the implicit processes of ageing and diseases associated with getting old, says Lange. A good example is our minds. As brain tissue gradually decreases with age, its normal for our memory to shift, to become slower and less efficient.But forgetting entirely and suffering from significant impairment is not universal, its a symptom of dementia (which is itself an umbrella term for many diseases).

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In 201415, almost three-quarters of Australians aged 65 and over reported they had good or very good health, according to the Australian Institute of Health and Welfare. But disease is more common in older people: in 2015, cancer and cardiovascular disease were the most prevalent followed by dementia, type 2 diabetes, chronic lung disease and osteoarthritis. Many of these illnesses are also the biggest killers.

Flicker says cancer is more common as people age partly because the bodys surveillance system becomes less likely to spot and destroy bad cells. We are more at risk of diabetes, in part because our body becomes less efficient at converting glucose to energy and requires more insulin.

Still, while everyones reserves decrease with age, we arent all similarly susceptible to disease. Some of us, Lange says, have higher baseline defences. So, even though someone may have pathologies such as hypertension and mini-strokes, both of which are linked to dementia, they wont necessarily develop a form of the disease.

Theres a cheeky saying in gerontology, says Byles: If you want to age well, pick your parents.

Being born with as few DNA errors as possible gives you a good headstart in life; aspects such as a good education, financial security and access to nutritious food in childhood add to your stocks.

You can be already on an un-level playing field, depending on what your early life is like, Byles says. If you get to older age and youre big and strong, with a healthy brain, good education, a strong immune system, they all go into your reserve ... you can maybe cope with having not as strong muscles or a decline in condition because you have all these other things that support you.

A quarter of how we age is determined by genetics, according to the World Health Organisation, and the rest comes down to lifestyle and socioeconomic factors.

More than a third (38 per cent) of the burden of disease in older Australians was preventable in 2015, according to the Australian Institute of Health and Welfare. Smoking, poor diet, being overweight or obese and high blood pressure were key contributors.

COVID-19 lockdowns, which limited exercise and socialising, have underlined just how important lifestyle is in ageing. Lange says the months in lockdown in Victoria had devastating impacts on physical and cognitive function for older people.

There are other factors outside our control.

Being brought up in poor housing, abject poverty, poor nutrition, a whole range of other things; all of that has contributed to our elders having chronic health conditions today.

Aunty Geraldine Atkinson at the launch of the Yoo-rrook Justice Commission in 2021.Credit:Simon Schluter

Social disadvantage is a big one. A 2020 study of 5000 Britons found that lower socioeconomic status led to an accelerated decline in ageing. The researchers pointed out that the rich tended to have, for example, better access to parks and fitness centres as well as mentally stimulating activities (social clubs, the arts), which all helped bolster physical and mental function. Meanwhile, those living in poverty usually experienced more life stresses, which affected health, and they could also be exposed to more environmental pollution.

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This disparity in ageing is reflected in Australian government policy. Subsidies for aged care services usually kick in at 65, but Indigenous Australians, Torres Strait Islanders and the homeless are at higher risk of health issues and financial inequality so are eligible at 50 (or 45 if they are both Indigenous and homeless).

The life expectancy of Indigenous Australians is about eight years less than for non-Indigenous Australians.

Aunty Geraldine Atkinson, a Bangerang woman and co-chair of the First Peoples Assembly of Victoria, says more must be done to support healthy ageing in Aboriginal communities.

Being brought up in poor housing, abject poverty, poor nutrition, a whole range of other things; all of that has contributed to our elders having chronic health conditions today, she says.

Credit:Illustration: Dionne Gain

Much research is being done to find a magic anti-ageing pill, but there is no strong evidence at the moment that supplements or medications work. Scientists are trying to find treatments that could lengthen telomeres, for example, or remove senescent cells via drugs or gene editing in the hope these could slow ageing.

The medical community is keeping a close eye on clinical trials underway to determine the effects of the drug Metformin, which is normally prescribed to manage blood-sugar in diabetics, but has shown broader age-targeting potential. Research previously suggested diabetic people who took the drug outlived non-diabetics who didnt, and it has been found to delay ageing in mice, although in high quantities it was toxic. The American Federation for Aging Research is examining whether it can also prevent heart disease, cancer and dementia.

Still, any geriatrician will tell you a balanced diet and regular exercise are key to supporting healthy ageing and, in turn, a longer life. Stimulating your mind also helps minimise disease risk, Gregorevic says.

Just like our muscles, use it or lose it our brains are like that as well, she says. One of the best things you can do for healthy ageing is just to keep having a go at things not brain training but staying engaged in life, socialising, learning new skills, learning a language.

Its never too early or too late to start. Byles encourages people to start planning for old age when young. If youre not doing it by your 50s, she says, thats when you must ask yourself, Where do I go from here, what do I want to protect in terms of bodily, social and mental functions?. Make changes that will maintain your wellbeing and keep you pushing your capacity to do things you enjoy.

The aptly named Professor Norman Lazarus laid out why he considered exercise, eating well and mental health a trinity in his book from 2020, The Lazarus Strategy: How to Age Well and Wisely. The Kings College London physician and researcher overhauled his lifestyle in his 50s to become a champion cyclist at 66, an age he said he expected to start having difficulty getting out of a chair or opening jars. At 86, he still cycles, trains at the gym, walks with his wife, watches his diet and works at the university.

At every age, I change my behaviour so that I can do the best I can with the physiological systems I have. And I dont look for immortality.

Norman Lazarus, 86, kickstarted his healthy lifestyle when he was 50.Credit:Liz Seabrook

Lazarus encourages people to first accept they are going to get old, and then change their lifestyle to truly enjoy the journey of ageing and retain their independence.

At every age, I change my behaviour so that I can do the best I can with the physiological systems I have. And I dont look for immortality, he says.

The trick is to prioritise things you love, so you stick to them, he says. While he and his wife now walk on flatter, gentler trails instead of on multi-day hikes, for example, they still relish the time together. He even uses the term exercise deficiency diseases to emphasise how key physical activity is.

A comprehensive study in 2015 found 26 common illnesses could be positively affected by exercise, including cardiovascular disease, type 2 diabetes, obesity, dementia, osteoarthritis, osteoporosis and some cancers.

The most effective anti-ageing option we have is exercise, Lange says. It produces beneficial effects for pretty much everything weve ever looked at.

Exercise improves muscle strength, balance, bone density, and the immune, cardiovascular and respiratory systems. It boosts mood and supports brain and spinal health, too. Getting out and being active with people is important for cognitive stimulation; and, by stressing the body, youre also getting it used to dealing with small perturbations.

Lange says just a small amount of activity can make a meaningful difference, and resistance training is particularly important he has seen this transform once-bedbound patients in their 80s and 90s. He encourages people to introduce incidental movement into their day: carry your shopping bags instead of wheeling a trolley, walk instead of drive or tend to your garden.

Even if you have the healthiest exercise, diet and social regimen in the world, though, you could still suffer from disease when older (or younger, for that matter). The harsh reality is that no matter what you do, youre going to die. And you can live the perfect lifestyle and still get cancer. Nothing is certain, Gregorevic says.

Its why we must be careful not to judge people for the condition theyre in when theyre older. Byles points out that people with certain illnesses, such as diabetes or lung disease, often get blamed. Some of it is preventable but not all of it. Some of it is by virtue of the fact youve been around a long time and have had a lot of chances to accumulate a problem, she says.

Part of the reason people dont notice their own ageing is because the changes are far too subtle, Flicker says. And people dont actually think theyre changing with age their vision of self is deeply ingrained.

Byles adds: I have a theory that everyone thinks theyre 30. You have a concept of yourself, so we always think were younger, which is great. But then we can get a shock.

She believes part of this is our own ageism, where we value our youth as more relevant. Indeed, we live in a culture that glorifies youth.

The acceptance of poorer service provision in aged care reflects an undervaluing of the worth of older people.

In Australias 2021 Royal Commission into Aged Care Quality and Safety, commissioner Lynelle Briggs found that ageism was systemic in Australia. The acceptance of poorer service provision in aged care reflects an undervaluing of the worth of older people, assumptions and stereotypes about older people and their capabilities, and ageism towards them. This must change, she wrote.

And a World Health Organisation global survey of more than 83,000 people found that one in two had ageist attitudes.

One of the great tragedies of ageism is that people internalise it and develop a negative bias against their older selves, Gregorevic says.

One common example of self-sabotage is that while young exercisers crave feeling out of breath, many older people, doubting their capabilities, take it to mean they should avoid being active, Lange says. [But] thats exercise, and its getting you used to those challenging activities, and the next time you get sick and need some extra heart and lung function, itll be there.

Its really important not to categorise everybody older than 65 as old ... Theres nothing magical about this age. It doesnt mean people are all of a sudden decrepit.

The idea that older people are incapable of using technology is another misconception. And Professor Linda Rosenman, board member of the Australian Association of Gerontology, says debates about retirement age generate another myth. I think its really important not to categorise everybody older than 65 as old, Rosenman says. This is just the age that people become eligible for government pensions. Theres nothing magical about this age. It doesnt mean people are all of a sudden decrepit.

Not all Australian communities suffer from ageism.

It seems not right, foreign, kind of, says Aunty Geraldine, explaining that Indigenous communities focus not on whats lost with age but instead on the wisdom thats gained. Its an approach she thinks the rest of the country could learn from.

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In Aboriginal culture, an elder is someone recognised for their knowledge and ongoing contribution to their community, and they are not neglected. They are traditionally referred to as Aunty or Uncle.

We always respect and value our elders, respect their cultural authority, respect the stories they told us ... and that gets passed down, Aunty Geraldine says. You become an Aunty not just to your bloodline, but to other younger people as well.

Its different in other countries, too.

When youre in Beijing and you go for a walk to parks, theyre full of older people doing tai chi, dancing. Theres no sense that, Im too old to do that, Byles says.

Byles, who helped create the anti-ageism Every Age Counts campaign, says people could be enjoying life more as they age.

Ageing is a great individual and societal success. We should be embracing it, she says.

Credit:Illustration: Dionne Gain

The fact is we do typically become happier as we age, with research showing older people tend to have brighter moods and fewer symptoms of depression and anxiety than younger counterparts.

Byles says its possible this is because older people largely do things that bring them satisfaction.You cant do all the things you used to do ... so you are actually focusing on things that are more important to you, she says.

You use your brain to solve problems throughout your life ... [and] each time you learn a new strategy you can apply it to other problems, and thats wisdom.

Plus, she says, we often care less about what other people think, which can be really liberating. And there is a sense of contentedness that comes from understanding, with time, where you and the puzzle pieces of your life fit.

People keep improving their vocabulary well into their 60s and 70s. And while brain speed and working memory peak in early life, this doesnt make 20-year-olds equipped mentally to run the country.

Older people have whats termed crystalline intelligence, Flicker says. You use your brain to solve problems throughout your life ... [and] each time you learn a new strategy you can apply it to other problems, and thats wisdom.

Reflecting on her own life, Rosenman considers herself to have become more patient and tolerant, and she enjoys having more time.

Youre not trying to climb the greasy pole yourself any more, and youre much more ready to mentor and help other people, she says. In many ways, life is a lot more enjoyable than when you were racing off to work and herding the kids ... [and] grandchildren are a big bonus.

Ageing is a great individual and societal success. We should be embracing it.

Professor Julie Byles says we should start planning for getting old at least by our 50s.Credit:Peter Stoop

There is, of course, an existential aspect to ageing. That can be quite difficult, Lange says. Ive met patients who have lived too long, and have outlived their partners and friends and even sometimes their own children, and they have increasing physical disability and sensory limitations.

But, Lange says, most people reach a point where they no longer fear dying.

People usually accept it will come ... which is quite freeing.

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Ageing: What is the process? And can we reverse it? - Sydney Morning Herald