Aging: From Fundamental Biology to Societal Impact

Aging: From Fundamental Biology to Societal Impact examines the interconnection of the cellular and molecular basis of aging and societal-based challenges and innovative interventions. Sections take a societal-based angle on aging, describing several flagship initiatives for healthy living and active aging in different regions, cover the biology of aging which includes the hallmarks of aging, explain the pathophysiology of aging, describing different comorbidities associated with aging and possible interventions to decrease the impact of aging, and envision future and innovative measures to tackle aging-related morbidities.

Contributions from an interdisciplinary panel of experts cover such topics as the biology of aging to physical activity, nutrition, psychology, pharmacology, health care, social care and urban planning.

• Provides a cross-disciplinary approach to aging at both the biological and societal level
• Highlights frontline scientific knowledge in the biology of aging and its translation into societal interventions
• Offers insights on the value of aging research and its future impact from a fundamental and translation point-of-view

• Language: English
• Publisher: Academic Press
• Release date: Sep 22, 2022
• ISBN: 9780128241318

Book preview

Front Cover for Aging - From Fundamental Biology to Societal Impact - 1st edition - by Paulo J. Oliveira, João O. Malva

Aging

From Fundamental Biology to Societal Impact

Edited by

Paulo J. Oliveira

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

João O. Malva

Coimbra Institute for Clinical and Biomedical Research (iCBR), Center for Innovative Biomedicine and Biotechnology (CIBB), Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Table of Contents

Cover image

Title page

Copyright

List of contributors

Foreword

Preface

Section 1: The societal burden of aging

Chapter 1. Global aging and health determinants in a changing world

Abstract

1.1 Introduction

1.2 The geographies of a global trend

1.3 Environmental health in later life

1.4 Global stressors in a changing world

1.5 Conclusion

Acknowledgments

References

Chapter 2. Flagship initiatives for healthy living and active aging in Europe: the European Innovation Partnership on Active and Healthy Ageing and the Reference Sites

Abstract

2.1 Demographic changes and aging

2.2 The European Innovation Partnership on Active and Healthy Ageing

2.3 Reference sites—case studies

2.4 Reference Site Collaborative Network

2.5 Transition from Horizon 2020 to Horizon Europe—the role of IN-4-Active and Healthy Ageing

2.6 Future perspectives

Acknowledgment

References

Chapter 3. Aging in Africa, challenges and opportunities—the particular case of Cabo Verde

Abstract

3.1 Aging in Africa and West African Region

3.2 Geography and climate of Cabo Verde

3.3 Cabo Verde, the historical healthy islands

3.4 Epidemiology of slave society

3.5 Cabo Verde Famines

3.6 Cabo Verdean population genetics

3.7 Age pyramid of Cabo Verdean population

3.8 Urbanization of Cabo Verdean population

3.9 Aging and the emergence of a new demographic model

3.10 Elderly in Cabo Verde

3.11 Health and national health service—philosophy, structures, and budget

3.12 Healthy and active aging policies

3.13 Aging and poverty

3.14 Aging and gender

3.15 To a healthy living and active aging in Cabo Verde—the future

References

Chapter 4. Flagship initiatives to prevent and treat diabetes as a burden of western societies

Abstract

4.1 Introduction

4.2 Impact of research: prediabetes

4.3 Lifestyle interventions

4.4 Impact of research: diabetes

4.5 Summary and conclusions

References

Chapter 5. Determining factors on active aging in Asia and Oceania: a systematic review

Abstract

5.1 Introduction

5.2 Methodology

5.3 Results

5.4 Discussion and concluding remarks

References

Chapter 6. Healthy living and active aging in Latin America and the Caribbean countries: biological, demographic, and epidemiological challenges

Abstract

6.1 Introduction

6.2 Demographic and epidemiological changes in the Latin America and the Caribbean countries

6.3 Age-related biological changes and diseases in the context of Latin America and the Caribbean countries

6.4 Health and social initiatives for the promotion of healthy living and active aging

6.5 Selected health issues among older people: evidence from long-term cohorts in Latin America

6.6 Conclusion

References

Section 2: The biology of aging

Chapter 7. Identification of metrics of molecular and cellular resilience in humans and animal models

Abstract

7.1 Biomedicine is focused on disease, not health

7.2 Comorbidities are the prevailing characteristic of older age

7.3 Chronological versus physiological age

7.4 Linking aging to disease: geroscience principles

7.5 A common thread: improvement of resilience

7.6 Defining resilience at the molecular level

7.7 Measuring molecular resilience

7.8 We need to develop resilience metrics in animal models

7.9 Translation of resilience measurements to humans

7.10 Conclusions

References

Chapter 8. A metabolic and mitochondrial angle on aging

Abstract

Abbreviations

8.1 Aging and longevity: revisiting the evolutionary perspectives and controversies

8.2 Aging and longevity: challenging the traditional views for mitochondrial-derived oxidative stress

8.3 Changes of mitochondrial function and structure associated with aging

8.4 A metabolic angle on aging

8.5 Oxidative stress and aging

8.6 Potential strategies against aging to increase longevity

8.7 Conclusions

Acknowledgments

References

Chapter 9. Intercellular communication and aging

Abstract

9.1 Importance of intercellular communication

9.2 The defining features of senescence

9.3 The mechanisms responsible for the induction of cellular senescence

9.4 Senescence associated secretory phenotype

9.5 Intercellular communication mediated by gap junctions and connexin channels

9.6 Intercellular communication mediated by tunneling nanotubes

9.7 Intercellular communication mediated by extracellular vesicles

9.8 Concluding remarks

Acknowledgments

References

Chapter 10. Genomic instability and aging

Abstract

10.1 Introduction

10.2 DNA strand breakage-induced genomic instability

10.3 Replication-induced genomic instability

10.4 Transcription-induced genomic instability

10.5 Nucleotide pools

10.6 Mitochondrial functions in genomic integrity

10.7 Genomic instability in health and disease

10.8 Aging interventions activating DNA repair

10.9 Conclusion and future perspectives

Acknowledgments

References

Chapter 11. Telomeres and cell homeostasis in aging

Abstract

11.1 What is cellular senescence

11.2 Link between cell senescence and telomeres

11.3 Critically short telomeres activate a DNA damage response and senescence

11.4 Telomere dysfunction can occur in a length-independent manner

11.5 Mechanisms by which stress accelerates telomere dysfunction

11.6 Telomere-associated DNA damage response foci accumulate during aging and disease

References

Chapter 12. Cellular senescence during aging

Abstract

12.1 Cell senescence is a complex stress response

12.2 The building blocks of the senescent phenotype

12.3 Senescence during aging in vivo

12.4 Senolytics and senostatics as anti-aging interventions

12.5 Conclusion

References

Chapter 13. The epigenetics of aging

Abstract

13.1 Introduction

13.2 Epigenetic alterations and aging

13.3 Epigenetic alterations and age-related diseases

13.4 Conclusions

Acknowledgment

Conflict of interest

References

Chapter 14. Disrupted cellular quality control mechanisms in aging

Abstract

14.1 Aging: is it a programmed fate and/or an error accumulation?

14.2 Autophagy: an evolutionarily conserved process

14.3 Role of autophagy in aging: what can go wrong?

14.4 The chase for eternal youth: can autophagy-directed interventions be the much-desired youth elixir?

14.5 Going down the rabbit hole: how lysosomes modulate longevity pathways

14.6 Partners in crime: mitochondria and lysosomes need each other

References

Chapter 15. Stem cells, fitness, and aging

Abstract

15.1 Introduction

15.2 Cell fitness and cell competition

15.3 Senescent mesenchymal stem cell phenotype

15.4 The functionality changes in senescent mesenchymal stem cells

15.5 The role of factors associated with aging

15.6 Genetic and epigenetic aspects

15.7 Senescence-associated secretory phenotype and the microenvironment

15.8 Therapeutic strategies to rejuvenate and increase fitness

15.9 Conclusion

Acknowledgments

References

Chapter 16. Programming of early aging

Abstract

16.1 Epidemiology of early life environment and adult aging—developmental origins of health, disease, and aging?

16.2 Early life nutrition and programming of adult aging and lifespan

16.3 Mechanisms underlying early programming of aging

16.4 Early programming of aging-related diseases

16.5 Transgenerational passage of the aging clock—reproductive cell plasticity and selection

16.6 Life interventions to Re-set the Clock

16.7 Conclusion

References

Section 3: Aging-related physiology, disease and prevention of aging-related diseases

Chapter 17. Polypharmacy and medication adherence

Abstract

17.1 Adherence to therapy and medication management

17.2 Concept of polypharmacy

17.3 Inappropriate polypharmacy management

17.4 Epilogue

References

Chapter 18. How molecular imaging studies can disentangle disease mechanisms in age-related neurodegenerative disorders

Abstract

18.1 Introduction

18.2 Molecular imaging of neuroinflammation

18.3 Molecular imaging of mitochondria dysfunction and oxidative stress

18.4 Molecular imaging of misfolded proteins

18.5 In vivo imaging of brain metabolic processes and activity

18.6 Imaging of iron accumulation

18.7 Emerging mechanisms of neurodegeneration

18.8 Translational use of molecular imaging in neurodegenerative diseases

18.9 Conclusions

References

Chapter 19. Physical frailty

Abstract

Abbreviations

19.1 The concept of frailty

19.2 Frailty assessment

19.3 The biology of frailty

19.4 Animal models of frailty

19.5 Interventions to attenuate frailty

19.6 Conclusion

References

Chapter 20. The extracellular matrix in cardiovascular aging

Abstract

Abbreviations

20.1 Introduction

20.2 Physiological alterations of the aged heart

20.3 Young cardiac extracellular matrix

20.4 Aged cardiac extracellular matrix

20.5 How does the aged heart respond to disease?

20.6 Conclusions and perspectives

Acknowledgments

References

Chapter 21. Aging-related neoplasia

Abstract

21.1 Introduction

21.2 Aging and the risk of cancer

21.3 Cellular senescence and carcinogenesis

21.4 Oxidative stress and carcinogenesis in aging

21.5 The hallmarks of aging and neoplasia

21.6 Neoplasias and aging

21.7 Conclusion

References

Chapter 22. Multidimensional frailty as an outcome of biological aging: immunosenescence and inflammaging in the life course perspective

Abstract

22.1 Introduction

22.2 Relevance of mechanisms of aging for medicine in the 21st century

22.3 Two facets of immunosenescence and inflammaging

22.4 Pathophysiological relevance of immunosenescence and inflammaging in the context of frailty: relevance for COVID-19

22.5 Concluding remarks and research outlook

References

Further reading

Chapter 23. Geroscience: a unifying view on aging as a risk factor

Abstract

23.1 Centenarians: a growing population

23.2 Morbidity compression in centenarians

23.3 Limits of human longevity

23.4 Exceptional aging must-haves

23.5 Exceptional homeostasis in exceptional aging

23.6 Centenarians beyond 120?

References

Section 4: The future and innovation in aging

Chapter 24. Aging support with socially assistive robots

Abstract

24.1 Introduction

24.2 Where is social robotics heading?

24.3 Results with a team of robots

24.4 User’s attributes from distributed, asynchronous data

24.5 Collectively cluster users into distinguishable profiles

24.6 Discussion

Acknowledgments

References

Chapter 25. Machine learning in the context of better healthcare in aging

Abstract

25.1 Introduction

25.2 Machine learning overview

25.3 A review of machine learning applications for aging research

25.4 Telemonitoring data mining for hearth failure management

25.5 Machine learning for the English Longitudinal Study of Ageing

25.6 Feature importance analysis

25.7 Conclusion

References

Chapter 26. The future of integrated care in aged individuals

Abstract

26.1 Introduction

26.2 The current model is more and more inadequate

26.3 The avoidable suffering

26.4 An integrated care approach

26.5 Key messages

References

Chapter 27. Moving from reactive to preventive medicine

Abstract

27.1 Introduction

27.2 Aging and major chronic diseases

27.3 The mechanistic interplay between aging and age-related diseases. In the search of evidence for preventive medicine

27.4 Age-related diseases—prevention initiatives are in order

27.5 Do we have preventive strategies for ameliorating age-related diseases?

27.6 Cardiovascular disease: the success of prevention

27.7 Low-density lipoproteins-cholesterol lowering: the lower, the better

27.8 Concluding remarks

References

Chapter 28. Personalized medicine: will it work for decreasing age-related morbidities?

Abstract

28.1 Introduction

28.2 Historical perspective

28.3 Slowing aging with GeroScience

28.4 Personalized medicine for optimal longevity

28.5 Emerging predictors of biological aging

28.6 Applying personalized medicine to GeroScience

28.7 Challenges and barriers to implementing personalized aging

28.8 Conclusion

References

Chapter 29. Interventions that target fundamental aging mechanisms: myths and realities

Abstract

29.1 Introduction

29.2 Pillars of aging

29.3 Genomic instability

29.4 Unitary theory of fundamental aging processes

29.5 Health span versus lifespan

29.6 Myths and realities

29.7 Clinical trials and treating disease

29.8 Conclusion

Conflict of interest disclosure

References

Chapter 30. Being a frail older person at a time of the COVID-19 pandemic

Abstract

30.1 Introduction

30.2 The community perspective

30.3 The hospital perspective

30.4 The nursing home perspective

30.5 Research on COVID-19 treatments and service development perspectives

30.6 Conclusions

Competing interest

Funding

References

Chapter 31. Aging: an illustrated adventure

Abstract

Index

Copyright

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List of contributors

Margarida Abrantes

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Raquel Alves

Laboratory of Oncobiology and Hematology and University Clinic of Hematology, Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Sharath Anugula,     Center for Healthy Aging, Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark

Veronica Aran,     Paulo Niemeyer State Brain Institute of the Health Secretariat of the State of Rio de Janeiro, Rio de Janeiro, Brazil

Lina Badimon

Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain

Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain

Autonomous University of Barcelona (UAB), Barcelona, Spain

Jorge N. Barreto,     Directorate National of Health, Ministry of Health and Social Security, Praia, Cabo Verde

Grzegorz Bartosz,     Department of Bioenergetics, Food Analysis and Microbiology, Institute of Food Technology and Nutrition, College of Natural Sciences, Rzeszow, Poland

Fernanda Borges,     CIQUP, Department of Chemistry and Biochemistry, School of Sciences, University of Porto, Porto, Portugal

Consuelo Borrás,     Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES-ISCIII, INCLIVA, Valencia, Spain

Maria Filomena Botelho

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Jean Bousquet,     MACVIA-France, Montpellier, France

António M.D. Brehm,     Human Genetics Laboratory, University of Madeira, Funchal, Portugal

Gerly A.C. Brito,     Department of Morphology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

Daan Bultje,     Healthy Ageing Network Northern Netherlands (HANNN), Groningen, The Netherlands

Ana Cristina Cabral,     Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal

André Caetano,     CNC - Centre for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Helena Canhão,     Lisbon AHA Reference Site, CHRC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal

Isabel Marques Carreira

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Ana Maria Carriazo,     Andalusia Reference Site, Regional Ministry of Health and Families of Andalusia, Seville, Spain

Cristina Carvalho

CNC - Centre Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal

IIIUC -Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Eugenia Carvalho

CNC - Centre Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal

IIIUC - Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal

Margarida Castel-Branco

Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal

Yaohua Chen

Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland

University of Lille, Inserm UMR-S1172, Lille Neurosciences & Cognition, Degenerative and Vascular Cognitive Disorders, CHU Lille, LiCEND, Lille, France

Department of Geriatrics, CHU Lille, Lille, France

João M. Coelho-Filho,     Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

Vera Constâncio

Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal

Department of Pathology and Molecular Immunology, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal

António Correia e Silva,     Faculty of Social Sciences, Humanities and Arts, University of Cabo Verde, Praia, Cabo Verde

Deiziane V.S. Costa

Department of Morphology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States

Elísio Costa,     UCIBIO REQUIMTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing (Porto4Ageing Reference Site), University of Porto, Porto, Portugal

Inês Costa,     Coimbra Institute for Clinical and Biomedical Research (iCBR), CIBB - Center for Innovative Biomedicine and Biotechnology, Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Teresa Cunha-Oliveira,     CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Cantanhede, Portugal

Paulo de Carvalho,     CISUC, Centre for Informatics and Systems of University of Coimbra, DEI, Coimbra, Portugal

Vicenzo De Luca,     Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy

Edoardo R. de Natale,     Neurodegeneration Imaging Group, University of Exeter Medical School, London, United Kingdom

Jorge Dias

Institute of Systems and Robotics, University of Coimbra, Coimbra, Portugal

Center for Autonomous Robotic Systems, Khalifa University, Abu Dhabi, UAE

Ronaldo P. Dias,     Laboratory of Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology, Center of Biomedicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

Ana I. Duarte

CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal

Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

CNC - Center for Neuroscience and Cell Biology, Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

John Farrel,     Reference Site Collaborative Network (RSCN), Brussels, Belgium

Fernando Fernandez-Llimos

Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal

Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal

Lino Ferreira

CNC - Center for Neuroscience and Cell Biology, CIBB — Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal

Luigi Ferrucci,     National Institute on Aging, Baltimore, MD, United States

Isabel Vitoria Figueiredo

Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal

Jamie K. Ford,     School of Public Health, Imperial College London, London, United Kingdom

Claudio Franceschi,     Institute of Information Technologies, Mathematics and Mechanics and Photonics Center, Department of Fundamental and Applied Research, National Research Lobachevsky State University of Nizhni Novgorod, Nizhny Novgorod, Russia

Alex A. Freitas,     School of Computing, University of Kent, Canterbury, United Kingdom

Maja Furlan de Brito

University of Coimbra, Faculty of Medicine, Coimbra, Portugal

King’s College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, United Kingdom

Karla C. Giacomin,     International Longevity Centre, Brazil. Centre for Studies in Public Health and Aging, Oswaldo Cruz Foundation, Belo Horizonte, MG, Brazil

Henrique Girao

University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal

Ilias Gkikas

Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology Hellas, Heraklion, Greece

Department of Biology, University of Crete, Heraklion, Greece

Bárbara Gomes

University of Coimbra, Faculty of Medicine, Coimbra, Portugal

King’s College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, United Kingdom

Rodrigo M. Gomes,     Department of Physiological Sciences, Biological Sciences Institute, Federal University of Goias, Goiania, Brazil

Ana Cristina Gonçalves

Laboratory of Oncobiology and Hematology and University Clinic of Hematology, Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Peter Goulden,     Icahn School of Medicine at Mount Sinai, Division of Endocrinology, Diabetes & Bone Disease, Department of Medicine, Mount Sinai Morningside & West, New York, NY, United States

Marcus Grant

Environmental Stewardship for Health of People and Planet, Bristol, England

Cities & Health, Bristol, England

Luís F. Grilo

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

PDBEB - PhD Programme in Experimental Biology and Biomedicine, IIIUC - Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal

Nick Guldemond

Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands

Faculty of Preventive Medicine, Department of Public Health and Healthcare NA Semashko, IM Sechenov First Moscow State Medical University, Moscow, Russia

Jorge Henriques,     CISUC, Centre for Informatics and Systems of University of Coimbra, DEI, Coimbra, Portugal

Manoela Heringer,     Paulo Niemeyer State Brain Institute of the Health Secretariat of the State of Rio de Janeiro, Rio de Janeiro, Brazil

Maddalena Illario,     Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy

Carmen Jerónimo

Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal

Department of Pathology and Molecular Immunology, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal

John G. Jones,     CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Joana Jorge

Laboratory of Oncobiology and Hematology and University Clinic of Hematology, Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Yaschar Kabiri,     Institute of Toxicology and Environmental Hygiene, Technical University of Munich, School of Medicine, Munich, Germany

Agnieszka Karkucinska-Wieckowska,     Department of Pathology, The Children’s Memorial Health Institute, Warsaw, Poland

George Kelly,     Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne, United Kingdom

James L. Kirkland

Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States

Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States

Kristina Kitaeva,     University of Nottingham, School of Veterinary Medicine and Science, Nottingham, United Kingdom

Andrey Kiyasov,     University of Nottingham, School of Veterinary Medicine and Science, Nottingham, United Kingdom

Viktor I. Korolchuk,     Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne, United Kingdom

Mafalda Laranjo

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Thomas J. LaRocca,     Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, United States

Marta Lavrador

Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR), mUniversity of Coimbra, Coimbra, Portugal

Magdalena Lebiedzinska-Arciszewska,     Laboratory of Mitochondrial Biology and Metabolism, University of Coimbra, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland

Zhiquan Li,     Center for Healthy Aging, Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark

Yuezhong Liu,     Ageing Research Institute for Society and Education (ARISE), Nanyang Technological University, Singapore

Alexandre Lourenço

Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal

Comprehensive Health Research Center (CHRC), Lisbon, Portugal

Lina Ma,     Xuanwu Hospital Capital Medical University, Beijing, P.R. China

João O. Malva,     Coimbra Institute for Clinical and Biomedical Research (iCBR), CIBB - Center for Innovative Biomedicine and Biotechnology, Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Christopher R. Martens,     Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, United States

Cristina Mas-Bargues,     Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES-ISCIII, INCLIVA, Valencia, Spain

Paulo Matafome

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR) and Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Joana Barbosa Melo

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Laboratory of Cytogenetics and Genomics, Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal

Maria L. Lima Mendonça,     National Institute of Public Health, Praia, Cabo Verde

Athanasios Metaxakis,     Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology Hellas, Heraklion, Greece

Lefkos T. Middleton

School of Public Health, Imperial College London, London, United Kingdom

Public Health Directorate, Imperial College NHS Healthcare Trust, London, United Kingdom

Paula I. Moreira

CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Laboratory of Physiology – Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Judite M. Nascimento,     Faculty of Science and Technology, University of Cabo Verde, Praia, Cabo Verde

Vivaldo M. Neto,     Paulo Niemeyer State Brain Institute of the Health Secretariat of the State of Rio de Janeiro, Rio de Janeiro, Brazil

Paulo J. Oliveira

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Alessandro Ori,     Leibniz Institute on Aging, Fritz Lipmann Institute (FLI), Jena, Germany

Reinaldo B. Oriá,     Laboratory of Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology, Center of Biomedicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

Susan E. Ozanne,     University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, United Kingdom

Miguel Padeiro

Centre of Studies in Geography and Spatial Planning (CEGOT), Coimbra, Portugal

Department of Geography and Tourism, Faculty of Arts and Humanities, University of Coimbra, Portugal

Teresa Padro

Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain

Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain

Carlos M. Palmeira

CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal

CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Department of Life Sciences, University of Coimbra, Coimbra, Portugal

Yiming Pan,     Xuanwu Hospital Capital Medical University, Beijing, P.R. China

Simão Paredes

Polytechnic of Coimbra, Coimbra Institute of Engineering, Coimbra, Portugal

CISUC, Centre for Informatics and Systems of University of Coimbra, DEI, Coimbra, Portugal

João F. Passos

Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States

Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, United States

Edith Pereira,     IHMT, Universidade Nova de Lisboa, Lisbon, Portugal

Francisco B. Pereira

Polytechnic of Coimbra, Coimbra Institute of Engineering, Coimbra, Portugal

CISUC, Centre for Informatics and Systems of University of Coimbra, DEI, Coimbra, Portugal

Susana P. Pereira

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Laboratory of Metabolism and Exercise (LametEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sport, University of Porto, Porto, Portugal

Paolo Pinton,     Department of Medical Sciences and Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, Ferrara, Italy

Joana F. Pires,     Multidisciplinary Institute of Ageing, University of Coimbra, Coimbra, Portugal

Salomé Pires

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Institute of Biophysics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

M. Cristina Polidori

Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University Hospital of Cologne, Cologne, Germany

Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany

Marios Politis,     Neurodegeneration Imaging Group, University of Exeter Medical School, London, United Kingdom

Nuno Raimundo

Multidisciplinary Institute of Ageing, University of Coimbra, Coimbra, Portugal

Penn State University College of Medicine, Department of Cellular and Molecular Physiology, Hershey, PA, United States

João Ramalho-Santos

Department of Life Sciences, University of Coimbra, Coimbra, Portugal

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Lene Juel Rasmussen,     Center for Healthy Aging, Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark

Fernando J. Regateiro,     Institute of Medical Genetics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Dario D. Reis,     Private Medical Practice, Praia, Cabo Verde

Caio Ribeiro,     School of Computing, University of Kent, Canterbury, United Kingdom

Ilda Patrícia Ribeiro

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Laboratory of Cytogenetics and Genomics, Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal

Teresa M. Ribeiro-Rodrigues

Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

CIBB - Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal

Albert Rizvanov,     University of Nottingham, School of Veterinary Medicine and Science, Nottingham, United Kingdom

Teresa Rocha

Polytechnic of Coimbra, Coimbra Institute of Engineering, Coimbra, Portugal

CISUC, Centre for Informatics and Systems of University of Coimbra, DEI, Coimbra, Portugal

Susanne Röhr

Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland

Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany

Anabela P. Rolo

CNC - Center for Neuroscience and Cell Biology, Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Department of Life Sciences, University of Coimbra, Coimbra, Portugal

Aurora Román-Domínguez,     Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES-ISCIII, INCLIVA, Valencia, Spain

Roman Romero-Ortuno

Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland

Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland

Mercer’s Institute for Successful Aging, St James’s Hospital, Dublin, Ireland

Manuel Santos Rosa,     Institute of Immunology, Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal

Catrin Rutland,     University of Nottingham, School of Veterinary Medicine and Science, Nottingham, United Kingdom

Izabela Sadowska-Bartosz,     Laboratory of Analytical Biochemistry, Institute of Food Technology and Nutrition, College of Natural Sciences, Rzeszow, Poland

Paula Santana

Centre of Studies in Geography and Spatial Planning (CEGOT), Coimbra, Portugal

Department of Geography and Tourism, Faculty of Arts and Humanities, University of Coimbra, Portugal

Deolinda Santinha

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal

Inter-University Doctoral Program in Aging and Chronic Diseases, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal

Marcos Santos,     Department of Dental Prosthesis and Materials, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

Ana Bela Sarmento Ribeiro

Laboratory of Oncobiology and Hematology and University Clinic of Hematology, Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal

Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal

Clinical Hematology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

Deisa S.R.C. Semedo,     Faculty of Social Sciences, Humanities and Arts, University of Cabo Verde, Praia, Cabo Verde

João Sequeira,     Institute of Systems and Robotics, IST–University of Lisbon, Lisbon, Portugal

Felipe Sierra,     Inspire, CHU Toulouse, Toulouse, France

Maria Natalina L. Silva,     Directorate National of Health, Ministry of Health and Social Security, Praia, Cabo Verde

Rafael Solana

Immunology and Allergy Group, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain

Department of Cell Biology, Physiology and Immunology, University of Córdoba, Córdoba, Spain

Immunology and Allergy Service, Reina Sofia University Hospital, Córdoba, Spain

Valeriya Solovyeva,     Kazan Federal University, Kazan, Russia

Hélder Spínola,     Human Genetics Laboratory, University of Madeira, Funchal, Portugal

Renata S. Tavares

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

IIIUC - Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal

Nektarios Tavernarakis

Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology Hellas, Heraklion, Greece

Department of Basic Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece

Tamar Tchkonia,     Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States

Yin-Leng Theng,     Ageing Research Institute for Society and Education (ARISE), Nanyang Technological University, Singapore

Vicente Traver-Salcedo,     ITACA, Universitat Politecnica de Valencia, Valencia, Spain

Chi Udeh-Momoh,     School of Public Health, Imperial College London, London, United Kingdom

Rakhi Verma,     Nanyang Business School, Nanyang Technological University, Singapore

Stella Victorelli

Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States

Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, United States

Andreia Vilaça

CNC - Center for Neuroscience and Cell Biology, CIBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal

CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands

Department of Molecular Genetics, Faculty of Sciences and Engineering, Maastricht University, Maastricht, Netherlands

PDBEB - PhD Programme in Experimental Biology and Biomedicine, IIIUC - Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal

Gemma Vilahur

Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain

Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain

José Viña,     Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES-ISCIII, INCLIVA, Valencia, Spain

Thomas von Zglinicki,     Newcastle University Biosciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom

Devin Wahl,     Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, United States

Berenice Maria Werle

Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland

Moriguchi Institute, Rio Grande do Sul, Brazil

Mariusz R. Wieckowski,     Laboratory of Mitochondrial Biology and Metabolism, University of Coimbra, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland

Heather Wilson,     Neurodegeneration Imaging Group, University of Exeter Medical School, London, United Kingdom

Erin O. Wissler Gerdes,     Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States

Lucyna A. Wozniak,     Lodz EIP AHA Reference Site, Medical University of Lodz, Lodz, Poland

Barbara Zavan,     Department of Translational Medicine, University of Ferrara (c/o CUBO), Ferrara, Italy

Yi Zhu,     Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States

Hans Zischka

Institute of Toxicology and Environmental Hygiene, Technical University of Munich, School of Medicine, Munich, Germany

Institute of Molecular Toxicology and Pharmacology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany

Foreword

Tom Kirkwood

The opening chapter of this book is titled Global aging and health determinants in a changing world. The world is of course always changing, but events of the recent past have brought fresh perspective to the traditional Spanish saying que no haya novedad (may no new thing arise). The COVID-19 pandemic has changed so much, particularly as it concerns the health of older people, whose increased susceptibility to the SARS-CoV-2 coronavirus has been alarmingly apparent. The implications of this emergency are properly considered in the book, but the majority of its chapters reflect the fact that the societal impacts of global aging have been and will remain a continuing challenge for life scientists, health experts, and those involved in social organization. Of course, there are crises to distract us, such as pandemics, the climate emergency, and geopolitical upheavals, but in the background the demographic changes caused by a combination of improved survival into old age and reduced birth rates mean that there are inevitable shifts still to come, for which we need to be better prepared.

A global scan of flagship initiatives for healthy living and active aging provides a good grouping of four chapters (on Europe, North America, Asia and Oceania, and Central and South America), which collectively set a positive tone to provide context for the rest of the book. The direction of travel is from fundamental biological mechanisms to aspects of age-related health and disease. The coverage is impressively comprehensive. For the reader with focused interests, the selection of chapters should offer the opportunity to dig in detail into the latest research. In addition, the collection as a whole might provide the impetus to think about connections. Aging is a process characterized by exceptional complexity, where not only is there the need for the best of reductionist enquiry but also it is essential to appreciate how the parts fit together. Mechanisms interact, often synergistically and with consequences at various levels of physiology. The subtitle of the book—From Fundamental Biology to Societal Impact—is therefore a call to arms as much as a description. We need to work together in interdisciplinary initiatives that span the traditional silos.

One of the fastest growing areas of science at present is that involving artificial intelligence technology—robotics, machine learning, and the exploitation of big data. Some hints of what is to come from these areas is described in two contrasting chapters on socially assistive robots and on machine learning to improve healthcare in aging. Further work, ongoing but not yet examined here, concerns the extension of machine learning to aid the exploration of these mechanisms.

Another traditional saying, this time an English one, tells us a stitch in time saves nine. Everything we are learning about the intrinsic biology of aging reinforces the idea that prevention is better (and probably more easily attainable) than a cure within the context of age-related diseases and frailty. Thus the focus on integrated care and preventive medicine toward the end of the book makes perfect sense, as does a well-informed assessment of myths and realities of potential antiaging interventions.

Returning to the COVID-19 pandemic, there are many important lessons still to be observed about how older people fit within our experience and management of what has hit us. Those involved in aging research have long appreciated how age is the single largest risk factor for so many illnesses, and how the presence of underlying multimorbidity makes the outlook worse. The harsh statistics of COVID-19 mortality have made everyone more clearly aware of this. At the same time that we work to protect older people from the virus, we must not fall into the age-old trap of simply regarding old people as being frail and vulnerable. The emphasis of this book, as a whole, is to display how aging is proving to be a scientifically tractable challenge, the solutions to which will create great benefits for individuals and across society.

Tom Kirkwood is an emeritus professor in aging at Newcastle University and affiliate professor in the Center for Healthy Aging at the University of Copenhagen.

Preface

Paulo J. Oliveira and João O. Malva

In recent decades, research in biomedicine has been delivering massive information about health determinants that are of utmost importance to inspire individuals and decision makers to fine-tune behaviors and public policies supporting healthy living. Science-based practices are the stepping stones to build healthier societies and support increased healthy life span expectations for all.

Population aging brings together the challenges and the opportunities to fight disease and to support healthy lifestyles, decreasing inequalities and delivering health. Population aging is a global growing phenomenon which is a major challenge creating the urgent need to deliver healthy aging opportunities for individuals and families, contributing to decrease the burden of aging and delivering sustainability of social and health-care support systems. Population aging is also an opportunity because it opens new windows for individuals to live longer and healthier and also because it brings opportunities for innovators and entrepreneurs to deliver new services and products for a growing silver market. Aging research and increases in a healthy life span are a new horizon for human kind, creating an entire new perspective for the deterministic view of health/disease dichotomy, broadening horizons for health maintenance as the default biological and societal program for all citizens. In fact, we are born to be alive and should be in good health until the last day of our life.

In this interdisciplinary book, we bring together a panel of highly recognized aging experts in different research and business fields, which tackles challenges and opportunities in an interdisciplinary and multisectoral perspective approaching the quest for healthy aging in a holistic manner.

Different elements of Aging: From Fundamental Biology to Societal Impact approach include the socioeconomic angle of aging, the role of collaborative innovation networks and their societal impact in different macroregions, the role of fundamental research and research-based knowledge to better understand molecular, metabolic, and cellular determinants of aging, cell reprograming and increased healthy life span, the burden of chronic diseases and multimorbidity restricting healthy life span, the use of innovation and technology assistance in delivering health and independent living technology-based support systems, the role of science awareness and health literacy to support behavioral changes in society, and inspiring citizens to adopt healthy lifestyles practices during the entire life course. At the end, the reader can find a very nice comic, which will guide them through a summary of the book’s contents.

We hope that the readers of this book will find the content accessible, informative, and useful. This book is part of the mission for science to pursue the limits of knowledge, opening new windows in our understanding of human life and its limits. By providing a collection of excellent chapters written by some of the best-known aging researchers, we expect to inspire students, young researchers, and citizens to join hands and support the aging research community.

Section 1

The societal burden of aging

Outline

Chapter 1 Global aging and health determinants in a changing world

Chapter 2 Flagship initiatives for healthy living and active aging in Europe: the European Innovation Partnership on Active and Healthy Ageing and the Reference Sites

Chapter 3 Aging in Africa, challenges and opportunities—the particular case of Cabo Verde

Chapter 4 Flagship initiatives to prevent and treat diabetes as a burden of western societies

Chapter 5 Determining factors on active aging in Asia and Oceania: a systematic review

Chapter 6 Healthy living and active aging in Latin America and the Caribbean countries: biological, demographic, and epidemiological challenges

Chapter 1

Global aging and health determinants in a changing world

Miguel Padeiro¹,², Paula Santana¹,² and Marcus Grant³,⁴,    ¹Centre of Studies in Geography and Spatial Planning (CEGOT), Coimbra, Portugal,    ²Department of Geography and Tourism, Faculty of Arts and Humanities, University of Coimbra, Portugal,    ³Environmental Stewardship for Health of People and Planet, Bristol, England,    ⁴Cities & Health, Bristol, England

Abstract

Aging is rapidly accelerating worldwide; by 2050, the number of people aged 65 and older will have more than doubled to reach 1.5 billion and represent 16% of the global population. In this chapter, we offer an overview of this demographic trend at the global scale. Beyond the global figures, demographic aging is characterized by many spatial variations across and within countries depending upon fertility levels, quality of health-care provision, socioeconomic development, social conditions, and population policies. We then examine how health and well-being in later life are related to the physical, social, and cultural environments in which older adults are embedded. We finally discuss how contemporary trends exert pressures on older adults, challenge their coping capacities, and pose real equity issues. In particular, four stressors are highlighted: (1) the prominence of neoliberalism and the welfare state retrenchment; (2) climate change; (3) the sharp increase in migration, both national and international; and (4) discriminations.

Keywords

Aging; health; population; well-being; Sustainable Development Goals; equity; geographical gerontology; environmental health

1.1 Introduction

Never before have humans lived as long as they do today. Life expectancy has more than doubled since 1900. Aging is rapidly accelerating worldwide and by 2050, the number of people aged 65 and older will have more than doubled to reach 1.5 billion and represent 16% of the global population.¹ While this trend is more intense in developed countries, with 26% of the population in Europe and North America aged 65 and older, it has now become a global phenomenon affecting developing countries as well.

With improving living conditions and an overall, yet patchy, improvement in healthcare, demographic aging has been accompanied by an increase in healthy life years. This has, in many cases, extended working life and provided new modalities of consumption and a flourishing age-related technological and service industry, the so-called silver economy. However, as the limits of human life are extended, aging is also characterized by an increasing number of older adults with socially and spatially-patterned frailty and chronic diseases and mortality and morbidity burdens, raising many health equity questions.

This chapter offers an overview of how the environment shapes health and well-being in later life. After briefly presenting the global demographic trends associated with aging, we examine how health and well-being in later life are related to the physical, social, and service environments in which older adults are embedded, and discuss how place of residence acts as a health determinant in later life. In the last section, we discuss four key stressors and their influence on health inequities in old age, including the changing role of welfare state, climate change, migrations, and discriminations.

1.2 The geographies of a global trend

1.2.1 Global patterns and projections

While 6% of the world population was aged 65 and older in 1990, that proportion grew to 9% in 2019.² Until recently, societal problems associated with new patterns of aging were frequently viewed as an issue only in western countries. In a United Nations Department of Economic and Social Affairs (UNDESA) report in 2015, the proportion of people aged 65 and older was 17.5% in UNDESA-defined more developed countries, and only 6.3% in less developed countries.³ When assessed by sustainable development goals (SDG) region, the countries with the largest proportion of people aged 65 and older were found in Europe, with the notable exception of Japan, the country with the longest life expectancy, 84.4 years in 2019.⁴ It is tempting to draw conclusions based on the world map (Fig. 1.1) and on general data (Table 1.1). Estimates for 2020 show that Europe and North America have the largest proportions of people aged 65 and older (18.3%), followed by Australia and New Zealand (16.2%). The lowest proportion is found in Sub-Saharan Africa (3.0%).

Figure 1.1 Estimates of people aged 65 and older in 2020. Data from standard population projections (UNDESA. World population prospects 2019 (dataset). United Nations; 2019).

Table 1.1

aHere Oceania does not include Australia and New Zealand.

bHere Europe and North America are considered separately, contrary to SDG regions.

Source: Data from UNDESA. World population prospects 2019 (dataset). United Nations; 2019.

These figures, however, should not obscure that, in absolute numbers and alongside the estimated 143 million people aged 65 and older living in Europe and the 62 million in North America, in 2020 there are estimated to be more than 60 million in Africa, 60 million in Latin America and the Caribbean, 124 million in Central and Southern Asia, and 272 million in Eastern and South-Eastern Asia. This brings the global total estimate of people aged 65 and older in 2020 to 727.6 million (Table 1.1).

Current forecasts indicate that population aging will continue to grow (Table 1.1). Globally, the proportion of people aged 65 and older is expected to reach 16% by 2050. By that time, 1.5 billion people are expected to be aged 65 and older, representing a 113% increase in 30 years. Reviewing absolute numbers is fundamental to assessing needs and determining future policies. In 2050, almost 200 million people aged 65 and older will be living in Sub-Saharan Africa, Northern Africa, or Western Asia; 900 million in Asia (Central and Southern Asia, Eastern and South-Eastern Asia); and almost 150 million in Latin America and the Caribbean. This totals 1.25 billion people aged 65 and older, compared to 200 million in Europe and 96 million in North America.²

Demographic aging has not only resulted from increased life expectancy, but is also related to fertility decline, with fertility rates declining in almost every country. In developed countries, total fertility rates (TFRs) are below the replacement level: 1.66 in Europe and North America for the period 2015–20, 1.84 in Australia and New Zealand, and 1.83 in Eastern and South-Eastern Asia (Fig. 1.2).² Other regions show higher numbers, but they also are declining. For example, the TFR in Sub-Saharan Africa was estimated at 4.72 for 2015–20 (vs. 5.88 in 1995–2000) and is expected to decrease to 2.67–3.66 in 2045–50 based on low and high variants projections.²

Figure 1.2 Predicted population growth of people aged 65 and older (2020–50). Data from standard population projections (UNDESA. World population prospects 2019 (dataset). United Nations; 2019.

At the same time, life expectancy is increasing in all parts of the world (Table 1.2). While Europe (78.3 years), North America (79.1 years), Australia and New Zealand (83.0 years) are leading in projected life expectancy at birth in 2015–20, other SDG regions are expected to see their life expectancy at birth approach 80 years by 2050. Northern Africa and Western Asia had a life expectancy at birth in 2015–20 of 73.4 years, which is projected to increase to 77.6 years by 2045–50, Eastern and South-Eastern Asia are projected to increase from 76.3 years to 79.8 years, and Latin America and the Caribbean are projected to increase from 75.2 years to 79.7 years.² Other regions are also expected to make significant gains in life expectancy at birth: Sub-Saharan Africa is projected to increase from 60.5 to 67.1 years, and Central and Southern Asia are projected to increase from 69.5 to 74.0 years.² Increasing longevity also means that the number and proportion of people aged 80 and older is projected to dramatically increase in the next decades (Table 1.3). While 5.3% of people living in Europe and 4.0% in North America are aged 80 and older in 2020, their proportion is projected to reach 10.1% and 8.7%, respectively, in 2050. In Eastern and South-Eastern Asia, this proportion is projected to rise from 2.1% to 7.3% in the same period. On a global scale, the projected proportion of people aged 80 and older is expected to increase from 145.5 million in 2020 to 426.4 million in 2050.

Table 1.2

aHere Oceania does not include Australia and New Zealand.

bHere Europe and North America are considered separately, contrary to SDG regions.

Source: Data from UNDESA. World population prospects 2019 (dataset). United Nations; 2019.

Table 1.3

aHere Oceania does not include Australia and New Zealand.

bHere Europe and North America are considered separately, contrary to SDG regions.

Source: Data from UNDESA. World population prospects 2019 (dataset). United Nations; 2019. Projections based on medium variant.

1.2.2 Multiscale intraregional variations of the aging process

Beyond these global figures, it is important to bear in mind two kinds of spatial variations: within regions and within countries. The first one concerns the existing diversity of drivers and situations across countries located in the same SDG region. These intraregional variations are explained by differences in fertility levels, quality of healthcare provision, socioeconomic development, social conditions, and population policies. In Europe, for example, the proportion of people aged 65 and older varies from 12.5% (Moldova) to 23.3% (Italy). In Eastern and South-Eastern Asia, the proportion ranges from 4.3% (Laos) to 28.4% (Japan), and in Latin America and the Caribbean from 5.0% (Honduras) to 21.7% (Martinique, an Overseas department of France).²

The second kind of variation exists between urban and rural areas within an individual country. Aging has traditionally been associated with a demographic decline in low-density rural areas, because there is a trend for younger adults to relocate to cities in search of jobs.⁵,⁶ This trend is frequently accentuated by a parallel relocation of retired people, who often leave cities and move to the countryside or coastal areas.⁷ While these processes still exist and are likely to increase in absolute numbers,⁸–¹⁰ and in many countries proportions of people aged 65 and older are higher in rural areas than in urban areas, increasing urbanization rates anticipate an increase in the number of older people in urban areas where they have been settled for several years or decades. This is already apparent in the proportion of urban dwellers in the total. Of people aged 65 and older, globally 58.8% of them lived in urban settings in 2015 versus 48.3% in 1990. The proportion is even higher in UNDESA-defined more developed regions, where 75% of people aged 65 and older live in urban areas, compared to 50% in less developed regions.³

1.3 Environmental health in later life

1.3.1 From successful aging to the role of place and inequities

The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.¹¹ This approach recognizes the existence of multiple determinants of individual health status and the mutual relationship between physical and mental health, which involves physiological, behavioral and social mechanisms.¹²,¹³ The deterioration in the health of older people is often described through the model of the disablement process.¹⁴,¹⁵ This corresponds to the gradual deterioration of various bodily functions, including: physiological (respiratory, cardiovascular, endocrine), motor (locomotion, resistance to effort), cognitive (memory, executive functions), and sensory (vision, hearing). This has long been seen as an intrinsic and inevitable evolution of aging, and has been used to justify a geriatric and socio-medical approach to health. However, this view neglects the transactional, social, and environmental determinants of health. Until the 1980s, the dominant social and behavioral theory of aging was that which was proposed by Cumming and Henry.¹⁶ Their disengagement theory described how older people progressively withdrew from activities and social relations, preparing for their own death and leaving the way for younger people.

Meanwhile, Havighurst’s activity theory of aging,¹⁷ later developed by Lemon, Bengtson and Peterson, Bengtson,¹⁸ asserted that keeping active was necessary to maintain one’s self-identity and meaningful life. While this theory shared with the disengagement perspective a common view of curtailing activities and social interactions,¹⁹ it departed from it by emphasizing the social needs of aging individuals. In this it would pave the way for the concept of successful aging.²⁰,²¹ Far from being locked in a slow and unavoidable disappearance, individuals had to proactively undertake changes in their habits such as diet, physical activity, and social engagement. The difference between usual and successful aging resided in their own attitudes, and the individual’s choice could lower the probability of disease and disease-related disability by increasing or maintaining a high cognitive and physical functional capacity, and by actively engaging with life. This concept became commonly accepted in public discourse and in research on aging.²²

This approach, however, was criticized for its overemphasis on the role of individuals and agency. Anchored in a Western researcher-driven perspective, this conception of successful aging and the new gerontology paradigm have led to an individualistic and normative approach. This has led to a stereotyped view of successful aging, and excluded others, such as ill or disabled older adults, from this vision of successful aging.²³,²⁴ The conceptualization of aging, health, and well-being as embedded in an individuals’ socio-cultural context was not fully recognized, and neither were socio-spatial inequities. Nonetheless, other perspectives already offered such an embedded view of aging. Environmental gerontology, traditionally developed by the psychological sciences,²⁵–²⁸ was the first discipline to develop a conceptual model linking people and their immediate environment, initially at the scale of their homes. The person-environment fit theory describes the interaction between an individual and their environment.²⁹,³⁰ If a person’s needs are met by their environment, this facilitates better health and well-being.

Researchers have gradually expanded the scale of the residential environment to include the context of the neighborhood³¹–³³ and then link local contextual elements to major societal, economic, and political developments. Part of this evolution is linked to Bronfenbrenner’s socio-ecological approach³⁴ that places the person in a multiscalar context, extending from the micro-system (the local context surrounding the individual) to the macro-system (the larger cultural and social context). This model, further developed and adapted to numerous fields of inquiry, provides a useful and popular framework for analyzing the ways in which a complex set of individual, interpersonal, and environmental factors (institutional, community/society, and policy) affect an individuals’ health and behavior. It is at the origin of the famous Dahlgren-Whitehead rainbow,³⁵ which focuses on social inequalities, and it has been applied to the built environment in Barton and Grant’s ecosystem model of health determinants (Fig. 1.3).³⁶

Figure 1.3 Ecosystem model of health determinants.³⁶, ³⁷

The way that aging is