“ELSA” and the End of Days

Contrary to common perception, older people greatly contribute to society. This participation ranges from the high-level aspects like participating in politics and business, to the more individualistic support to the younger generation financially, practically and by sharing of their knowledge and experience.

But is anyone looking at how the older folk live, especially during their twilight years leading to their death? Fortunately, the answer is yes. There are several studies that look at ageing and mortality, and what seems to emerge is that heart disease seems to be one of the commonest causes of death in the older age group. Other causes of death include cancer and infections. In addition to that, Type 2 Diabetes, a very common problem in the aged, also worsens the risk of heart disease. Heart disease is also the leading cause of death in people with diabetes. This issue of Diabetes Health rightly focuses on how people with diabetes can take care of the heart and keep it beating. Literally speaking, we are alive till our heart has stopped, a heart- stopping truth if there ever was one!

One of the key studies looking at ageing and health is called ELSA (English Longitudinal Study of Aging), studying about 19,000 people over a long period. This study is unique because in addition to conventional health related factors like blood glucose, blood pressure, frailty and cardiac risk, this study also measures the social determinants of health, such as psychology, money and loneliness. In a recent report by the ELSA team, it was mentioned that inequality drives every aspect of ageing. People with more education, higher level jobs, and better income live longer, and have better well-being and cognition. As an individual writing this article, or as another reading this article- you and I have no means to change this overnight.

What we can change, though, is seen in one striking observation from the ELSA Study. A sub-study of the ELSA asked people to rate how worthwhile their activities were. Older people with a sense of purpose live longer than people who felt that their life and activities did not have purpose. It is not clear if it is the reverse which is causal, i.e. that people with good health can find purpose easily. However, the ELSA team highlight a very strong link between survival and having a sense of purpose. Probably, the benefits accrue from the impact of a purpose-filled life on our longevity-related genes and their functions, part of the emerging science called “epigenetics”.

But how can one find a purpose in life, especially in old age. Well, the answer lies in what Professor Andrew Steptoe, a lead investigator of ELSA, calls ageing “disgracefully”. This is a calling for rejection of conventional age related stereotypes and patterns of living. Outdated concepts that ageing is a time for peaceful contemplation and retirement may not necessarily be true for all. It is better to forge your own path towards a self-fulfilling and harmonious old age.

Happy, purpose-filled reading to all of you!

Dr Unnikrishnan AG

Editor