How to live well for as long as possible: 3 health models

It's a fact: we are all living longer, and life expectancy in both industrialized and developing countries continues to rise. Every year, we gain about three months of life expectancy, and one out of two female children is likely to live to 100 years.

Unfortunately, our healthy life expectancy—that is, living without chronic diseases or disabilities—stagnate. In other words, while we may live longer, we will likely spend more years in poor health.

A recent British study shows that the number of people aged 85 and older with at least four different types of medical conditions will double by 2035. Those currently aged 50 to 60 are at the greatest risk of developing two or three chronic diseases.

Yet, other studies indicate that preserving one’s health is not incompatible with aging: two-thirds of non-communicable diseases responsible for premature deaths can be prevented.

There are at least three health models that must be used together to mitigate the impact of aging on our health: preventive medicine, anti-aging medicine, and lifestyle medicine.

We can indeed improve our chances of aging well by detecting early pathophysiological changes that may impact our health in the years to come.

One of the most effective tools used by preventive medicine is the health check-up.

A health check-up is essentially the most thorough medical examination designed to detect medical problems in their early stages, when treatment is most effective.

A health check-up is a comprehensive medical assessment typically conducted by an internal medicine specialist in an otherwise healthy person, with a dual objective:

• To diagnose potential latent diseases and treat them.

• To identify risk factors that may impact future health and eliminate them.

This has become possible through the development of advanced medical technology: a wide range of biological assessments, including genetic and epigenetic tests, imaging techniques (standard X-rays, CT scans, ultrasounds, MRI), and functional tests now enable a precise, comprehensive analysis of living organisms.

Some of these tests are not only diagnostic but also predictive. Thanks to these tests, it is possible to reasonably predict the onset of a health issue and take appropriate preventive measures.

Age itself is the number one risk factor that compromises our health.

Aging is characterized by increased frailty, a higher susceptibility to diseases, and a significant increase in the risk of disability and death.

Senescence, i.e., the range of pathophysiological alterations that occur with aging, should no longer be viewed as an inevitable part of life but rather redefined as a medical problem and a target for biomedical intervention.

Over the past decade, substantial progress has been made in understanding the fundamental biological mechanisms underlying the aging process. While it is naturally impossible to prevent chronological aging, it is now possible to slow physiological aging and prevent pathological aging.

The availability of cutting-edge biotechnologies has led to the development of strategies aimed at delaying or reversing the harmful changes once considered "normal" aging but nonetheless involved in the development of multiple age-related pathological conditions.

In this context, aging medicine, sometimes referred to as anti-aging medicine, has recently entered the medical landscape. Aging medicine is a new field of preventive medicine based on the application of advanced scientific knowledge and innovative biotechnologies for the early detection, prevention, treatment, and repair of age-related dysfunctions and diseases.

Its goal is to extend healthy life expectancy by developing strategies to maintain a high quality of life for individuals in the second half of their lives. It is part of the broader medical and scientific effort to confine morbidity to the biological limits of human life.

Lifestyle medicine is an emerging field that addresses the major health behaviors responsible for most premature deaths.

The key targets include nutrition, weight management, physical activity, well-being, stress management, spirituality, substance use, connectivity, and sleep enhancement. Ultimately, the role of lifestyle medicine is to optimize the trajectory of aging, leading to a compression of morbidity at the end of life.

Regardless of our genetic inheritance, we can influence the pace of our aging through our lifestyle choices and the environmental conditions to which we expose ourselves.

Unhealthy lifestyles are at the root of the global burden of chronic diseases, accounting for approximately 63% of all deaths. Lifestyle-related conditions represent a growing public health issue, reaching epidemic proportions worldwide.

Providing evidence-based strategies for behavior change can help individuals make sustainable choices in key areas such as physical activity, healthy eating, weight management, sleep improvement, cessation of alcohol and tobacco use, well-being, and stress management.

Health habits established early and practiced throughout life influence not only our longevity but also the quality of health we experience in adulthood. 

Obesity, metabolic syndrome, diabetes, hypertension, atherosclerosis, asthma, chronic obstructive pulmonary disease (COPD), cognitive disorders, certain neurodegenerative and autoimmune diseases, and breast, prostate, and colon cancers are all conditions for which effective prevention through simple lifestyle modification has been scientifically demonstrated.

The biological mechanisms behind this preventive action are partially understood. Our lifestyle directly impacts how our genes are expressed. Environmental factors and lifestyle choices influence epigenetic mechanisms, such as DNA methylation, histone acetylation, and microRNA expression, which in turn regulate gene activity.

The most compelling example is that of identical twins. Identical twins share the same genetic makeup, but when raised in different environments, they exhibit different patterns of DNA methylation, which may contribute to varying disease susceptibilities between them.

Since epigenetic markers like DNA methylation can be faithfully copied between successive generations of cells, epigenetics may also explain how a fetus's or child's environment can influence future disease susceptibility.

It is becoming increasingly clear that unfavorable changes in epigenetic programming due to unhealthy lifestyles play a role in numerous pathological conditions like those mentioned above.