Comment

Health systems have adopted models of integrated care to better align services around the needs of aging populations. The results are encouraging, but inconsistent. Although they are untested, recent approaches — such as the WHO’s ‘Integrated Care for Older People’ — that are explicitly person-centered suggest that more-radical reform may be possible.

China faces urgent challenges associated with population aging. In this Comment, we summarize China’s adoption of long-term care insurance and underscore its importance for social and economic wellbeing. We provide recommendations for a future of sustainable and healthy aging in China.

The intestinal epithelium serves as a barrier that facilitates interaction between intrinsic and environmental factors. Aging is accompanied by the gradual deterioration of this barrier. We postulate that barrier dysfunction results from defects in epithelial membrane trafficking that exacerbate age-related metabolic imbalances. Herein, we integrate barrier integrity, protein homeostasis, membrane trafficking and intracellular lipid sensing into an age-determining mechanism.

Aging is a major risk factor for vascular disease. Increased levels of milk fat globule-EGF factor 8 (MFG-E8) are associated with many age-related arterial changes, but the mechanisms remain unclear. We propose that these detrimental effects may result from medin, a fragment of MFG-E8 that forms a highly common vascular amyloid.

Population aging is a global challenge that poses particular difficulties for low- and middle-income countries (LMICs). So far, there is a dearth of data that describe how aging affects Arab LMICs, which have distinct family structures, caregiving traditions, medical challenges and exposure to climate change. The planned Longitudinal Study of Egyptian Healthy Aging (AL-SEHA) — a member of the cross-nationally comparative family of aging studies around the world — is designed to address these knowledge gaps.

Studies have identified sex and/or gender differences in Alzheimer’s disease, but few have examined other dementias. We highlight sex and gender differences in other dementias, discuss sociocultural factors and provide a framework for future global studies.

The World Health Organization (WHO) blueprint for dementia research provides a roadmap to addressing the challenges in the field and reshaping our approach to dementia research. This Comment focuses on how to operationalize the drivers of research highlighted in the blueprint to make research more equitable, impactful and global.

A major transformation in dementia diagnosis and care appears imminent and will depend on three major types of biomarkers: molecular imaging, blood-based biomarkers and cerebrospinal fluid biomarkers. Each modality has unique strengths and limitations that suggest its optimal uses in research, clinical trials and clinical diagnosis.

The Global Council on Brain Health summarizes disparities that occur among the opportunities of different groups for adopting and sustaining brain-healthy behaviors across the lifespan. Here, we highlight challenges for people to maintain a healthy mind throughout their lives and suggest solutions for society to help people to achieve greater equity in brain health.

There is tremendous interest in the development of drugs that target senescent cells (‘senolytic’ drugs) to treat a range of age-related morbidities. However, studies in mice that demonstrate impaired tissue repair following clearance of senescent cells raise questions about the potential risks of senolytic therapies. Closer examination of the available studies reveals the hopeful possibility of a ‘therapeutic window’ in which these risks can be minimized.

The US National Academy of Medicine (NAM)’s first global grand challenge is dedicated to healthy longevity. We summarize the NAM’s Global Roadmap for Healthy Longevity, highlighting evidence that societies can benefit from untapped human, social and economic capital through investments throughout the life course.

In the age of rapid technological advance there are myths about older adults’ difficulties in using technology. Here I will debunk two common myths: first, the idea that age-related functional decline is entirely responsible; and second, the notion that everyone will be technologically adept once today’s older adults are gone.

The successful adoption and use of technology products and services for older adults remain limited. Although technological developments promise improved quality of life for older adults, ageism and access gaps impede their use. Implications and recommendations the design and distribution of new technologies for aging in place are discussed.

Currently, there are no evidence-based interventions to prevent and respond to abuse of older people. We propose to create, within the Decade of Healthy Ageing 2021–2030, an intervention accelerator to speed up the development of effective interventions for abuse of older people in community and institutional settings within low-, middle- and high-income countries.

The aging research field has largely focused on reversing aging-related changes in the body. However, emerging evidence about the gut microbiome indicates that it may not be optimal to just turn back the clock. Here, we advocate for a more tailored and function-focused approach promoting health across the lifespan.

Aging can be conceptualized as the stochastic accumulation of damage and loss of resilience leading to organism demise. Resilience mechanisms that repair, recycle or replace damaged molecules and organelles are energy-demanding, therefore energy availability is essential to healthy aging. We propose that changes in mitochondrial and energy status regulate RNA splicing and that splicing is a resilience strategy that preserves energetic homeostasis with aging.

Plasma biomarkers pertaining to the underlying pathophysiology of Alzheimer’s disease have recently become available (for example, amyloid beta and phosphorylated tau). The utility of these markers poses a question for clinicians (now and in the future): are plasma biomarkers for Alzheimer’s disease are ready for clinical use at this time?

The Longitudinal Aging Study in India (LASI), the largest national health and retirement study in the world, released its wave 1 microdata earlier this year. The principal investigators of LASI introduce the study and explain how it can advance aging research in India and beyond in response to the impending challenges of rapid population aging.

There is a major and rapidly growing deficiency in the US eldercare workforce at all levels, especially among physicians. Efforts to increase recruitment and retention into geriatrics have failed, especially among critically important educators and researchers. Possible strategies to assure adequate care for older persons are discussed.

COVID-19 has highlighted pervasive ageism and the interconnectedness of individuals and societies. This Comment discusses how creating an anti-ageist healthcare system will improve health outcomes for our current and future selves.