As time goes by

You must remember this
The fundamental things apply
As time goes by
No matter what the future brings
As time goes by
It’s still the same old story
A fight for love and glory
A case of do or die
As time goes by

This is a very personalised excerpt of the lyrics for the famous Casablanca song…

I am not going to talk about love but of the inevitability of the effects of time on humans, as on any other living thing on Earth.

As time goes by, human beings go through a process of changes that in medicine is called ageing.

Ageing is the process of growing old or maturing, the gradual changes in the structure of a mature organism that occur normally over time and increase the probability of death. Someone that is ageing is becoming older and less healthy or efficient.

The process of becoming older does not depend on time alone, as it is a process that is genetically determined and environmentally modulated.

The causes of ageing are uncertain, current theories are assigned to the damage concept, whereby the accumulation of damage may cause biological systems to fail, or to the programmed ageing concept, whereby internal processes may cause ageing.

In humans, ageing represents the accumulation of changes in a human being over time, encompassing physical, psychological and social changes.

Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand. Ageing is among the greatest known risk factors for most human diseases: of the roughly 150,000 people who die each day across the globe, about two-thirds die from age-related causes.

Ageing factors

The factors considered to influence biological ageing fall into two main categories, programmed and damage-related.

Programmed factors follow a biological timetable, perhaps one that might be a continuation of the one that regulates childhood growth and development. This regulation would depend on changes in gene expression that affect the systems responsible for maintenance, repair and defence responses.

The cellular balance between energy generation and consumption (energy homeostasis) requires tight regulation during ageing.

Damage-related factors include internal and environmental assaults to living organisms that induce cumulative damage at various levels. This is based on the concept that damage, either due to normal toxic by-products of metabolism or inefficient repair/defensive systems, accumulates throughout the entire lifespan and causes ageing.

DNA damage is thought to be the common basis of both cancer and ageing, and it has been argued that intrinsic causes of DNA damage are the most important drivers of ageing.

DNA damage causes the cells to stop dividing hence hindering regeneration.

A simple way of defining the ageing factors is the “wear-and-tear” theory: the very generalised idea that changes associated with ageing are the result of chance damage that accumulates over time.

Delaying, prevention and lifestyle

Caloric restriction substantially affects lifespan in many animals, including the ability to delay or prevent many age-related diseases.

There does not exist lifespan data for humans on a calorie-restricted diet, but several reports support protection from age-related diseases.

The Mediterranean diet is credited with lowering the risk of heart disease and early death. The major contributors to mortality risk reduction appear to be a higher consumption of vegetables, fish, fruits, nuts and monounsaturated fatty acids, like olive oil.

Moderate levels of exercise have been correlated with preventing ageing and improving quality of life by reducing inflammatory potential.

The amount of sleep has also a very relevant impact on mortality. People who live the longest report sleeping for six to seven hours each night. Lack of sleep (<5 hours) more than doubles the risk of death from cardiovascular disease, but too much sleep (>9 hours) is associated with a doubling of the risk of death, though not primarily from cardiovascular disease. Sleeping more than 7-8 hours per day has been consistently associated with increased mortality, though the cause is probably other factors such as depression and socioeconomic status, which would correlate statistically.

Classifying age

There are different ways of classifying age. In other words, chronological ageing may be distinguished from “social ageing”, cultural age-expectations of how people should act as they grow older and “biological ageing”, an organism’s physical state as it ages.

With age, inevitable biological changes occur that increase the risk of illness and disability.

As ageing is inevitable, positive self-perception of health has been correlated with higher wellbeing and reduced mortality in the elderly.

As people age, subjective health remains relatively stable, even though objective health worsens. In fact, perceived health improves with age! The older people get, the more they may consider themselves in better health than their same-aged peers.

This phenomenon is known as the “paradox of ageing”.

Successful ageing can be characterised as involving three components:
■ Freedom from disease and disability.
■ High cognitive and physical functioning.
■ Social and productive engagement.

It has become clearer and clearer that ageing is a result of a significant number of causes and counteracting one or several of them should not make a significant difference. Actually, the causes of ageing are synergizing and it has been concluded that none of them is the major one.

Lifespan might be significantly extended if we eliminate or even attenuate the increase of a few or even just one of the causes of ageing.

Ageing has long been seen as a result of errors of many kinds but is more than that.

Research may one day help slow the ageing process, extend human life, and keep humankind active and healthy for longer.

Clearly, old is not what it used to be. And the definition continues to evolve.

Benjamin Franklin once declared that “we get old too soon and wise too late”.

Applying a little wisdom may keep us humans from ageing before our time.

Be wise to enjoy a full and longer lifetime.

Best health wishes,
Dr. Maria Alice

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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service / Medilagos. Medical Director – Grupo Hospital Particular do Algarve