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National Yang Ming Chiao Tung University


  • Feature Column

  • Publish Date:2024-05-23
The Purpose of Geriatrics: Ensuring a Quality Life in Old Age
The Purpose of Geriatrics: Ensuring a Quality Life in Old Age
(Photo from Africa images)
By Professor Liang-Kung Chen, Director of the Center for Healthy Longevity and Aging Sciences at NYCU
Translated by Hsuchuan
Edited by Chance Lai

Discussing "aging" fundamentally reveals a complex issue. The age recorded on an ID card continuously increases, but this does not necessarily align with the biological aging process. This is a concept that everyone can understand, yet there has never been an excellent method to measure the difference between the two.

When discussing geriatrics, it primarily refers to medical and caregiving aspects. However, most of our research focuses on "Aging Sciences," such as the deterioration of bodily functions, decline in abilities, and susceptibility to illnesses. The endpoint of life is death, and the period leading up to death might transcend the scope of medicine. It prompts a philosophical reflection on what we want from our lives.

A well-known aging scientist, Aubrey de Grey, once boldly predicted that the human lifespan could reach a thousand years with several technological breakthroughs. This idea caused significant panic because people didn't know what they would do with such a long life. This prediction prompts substantial reflection among researchers and medical professionals like us. The goal of advancements in technology and medicine should be to help humans live better lives, not to extend life endlessly.

Overall, the trend of increasing human longevity will stay the same. The average life expectancy in Taiwan is about 80 years, with around 8 of those years requiring care from others, as individuals cannot fully take care of themselves. Therefore, our research focuses on "shortening the unhealthy years of life," aiming to reduce the time people need care. In other words, we strive for longevity and health, enabling people to enjoy a quality life in their later years.

Queen Elizabeth II exemplifies the widely accepted ideal in recent years. She was long-lived and healthy, remaining active, sharp-minded, and significantly contributing to society and international affairs. Her life ended peacefully in a single day without suffering.

Aging: A Multifaceted State Beyond Functionality
Aging: A Multifaceted State Beyond Functionality
(Photo from Pixabay)

Numerous physiological factors influence whether individuals will need caregiving in their old age. Operational definitions include mobility, cognitive abilities, vitality, hearing, vision, and emotional and psychological well-being. When illness strikes, there can be a sudden decline; for example, some may experience strokes, leading to a decrease in overall bodily function. Reliance on physiological functions becomes crucial at such times, with support from technological environments and support systems.

For example, during the Beijing Olympics, a sprinter from South Africa ran the 100-meter race. Both of his legs were amputated below the knees replaced with prosthetic blades. If we were to discuss his speed in the 100-meter race solely based on his "functional performance," who would indeed be considered a "disabled person" between him and me? It could be me, with legs, unable to outrun someone like him. Assistive technology can significantly compensate for physiological challenges.

Returning to a more biological perspective, we understand the importance of "function," but how should we discuss "function" exactly? It is a holistic manifestation. For instance, patients with degenerative conditions like osteoarthritis or Parkinson's disease may exhibit difficulty walking. It's worth noting that this discussion of function is approached from the perspective of attributing outcomes to diseases. However, "aging" may not appear as a disease but can result in poor functional performance.

Even in dementia cases, some individuals may no longer recognize those around them, yet their physical abilities remain intact. Conversely, there are cases where cognitive function is only mildly impaired, but assistance with mobility is already required.

The aging process of humans is a complex interplay of all these factors, which cannot be separated. What's exciting yet paradoxical is that these cases have traditionally been simplified into single disease models in medical discourse. In biomedical research, efforts have been focused on exploring the etiology within these single models. It is precisely because we often need to discuss the overall context that it becomes difficult to address the problems of human life.

Beyond Singular Models: Redefining Aging Research

Beyond Singular Models: Redefining Aging Research
(Photo from Getty Images)

In medical research, contexts are often simplified to obtain a cleaner analysis, but the information derived from these simplifications may only be applicable in some situations. For example, a few years ago, a clinical trial published in the New England Journal of Medicine focused on hypertension in individuals aged 75 and above. The conclusion was that for individuals aged 75 and above, blood pressure should ideally be controlled below 125/75 mmHg.

This study's conclusion seems "peculiar to those conducting geriatric research." Although the study design and execution were of exceptionally high quality, its overly simplistic inclusion criteria have limited the applicability of its conclusions. The study focused on individuals aged 75 and above but excluded common conditions in the elderly, such as diabetes, stroke, heart disease, chronic kidney disease, and polypharmacy. Our community surveys have found that less than 10% of individuals over 75 meet such criteria in the real world.

If we fail to consider the actual circumstances and simply apply the information derived from such simplifications to every elderly individual, we would be making a grave mistake and deviating from the intended meaning of the study.

Aging is a complex state with multiple intertwined expressions. Therefore, the core focus of aging research should be on the inevitable aging process in humans. It should target individuals at risk of declining in both physical and cognitive functions. Early and effective interventions for this group can alter their lives, reduce unhealthy years of life, and ultimately reshape society.

Please refer to the original text (Mandarin) for details.