Paul Irving, chairman of the Center for the Future of Aging at the Milken Institute and distinguished scholar in residence at the USC Leonard Davis School of Gerontology, joins Professor George Shannon in a conversation that sheds light on the need to prepare for growing older, reasons to resist retiring, the value of volunteering and other opportunities of aging.

Paul Irving quotes from this episode:

On the importance of planning and preparation

“This is the single thing that we all have in common, if we're lucky. We don't have race and gender and ethnicity and religion, but we all have aging. And yet, for some reason, this is something that people don't want to talk about as much as they should [and] don't want to prepare for. So, I think that for all of us who spend time thinking about this, [we should be] talking about it, communicating about it, [and] expressing that urgency. Not just for older adults, but for young people as well.”

On the value of volunteering    

“[It’s] not just that volunteering and service to youth is good for the beneficiaries, which is kind of intuitive. … The health benefits for the older volunteers are mind blowing. So the point is doing this work is not just good for the world. It's not just good for young people. It's good for your health. Every year, in addition to taking blood and doing all the other things that the doctor does when he or she pushes and prods and pokes, the doctor should say to you, ‘So, tell me about your volunteering,’ and maybe give you a prescription for a little bit more time with young people.”

On the benefits of employing intergenerational teams

“Older workers and younger workers bring different things to workplaces, different characteristics. The speed, the creativity and the risk-taking characteristics of youth; the balance, multi-sectoral problem solving and opportunity-creating understanding of age; and the understanding of how to navigate environments and get things done. There's some research that suggests that intergenerational teams, that mixed-age teams, actually outperform same age teams of any age. … I think that global employers are beginning to get it. It's beginning to happen in the United States.”

On the power of positive portrayals of aging                                                                                                     

“Older adults are as diverse as any other population with the same ups and downs. And I think Hollywood can play a really, really important role — and Madison Avenue too — in changing attitudes and, frankly, changing attitudes faster. I'll just add that I think things actually are moving. There's organic change going on now, and the only thing that concerns me is I think it's not going fast enough. So the question is, what can we do to catalyze it, accelerate it, [and] push it?”

On the business case for catering to older consumers                                                                                    

“Older adults make up a growing percentage of the population.. It's the market of the future. Get over the notion that older adults aren't consuming; get over the notion that older adults can't be attracted to travel and cars and clothes and food and all the rest. Enlightened executives in show business, advertising, etc. should be looking at that market and saying, ‘how do we produce more for this group?’”

Mara Mather, Professor of Gerontology and Psychology at the USC Leonard Davis School of Gerontology, is shedding light on how we learn, what we remember, and where we might find clues to slowing the progression of Alzheimer's disease.

Quotes from this episode:

"What is it that you remember? The things that you remember are typically the things that were really emotional in your life that mattered to you, that were surprising, that stood out. And we also can notice ourselves how much we tend to have gaps in some of these memories. And so scientists have been interested in this for a very long time."

"We looked at a sample of several hundred adults and we found among the older adults that the integrity of the locus coeruleus or this brightness that it shows on our MRI images because of its magnetic properties – as that declines with age, it seems that the locus coeruleus is probably showing some neuronal loss. And we found that that signal was associated with how well people did on memory tests. So people who showed what looked like a more intact locus coeruleus were doing better on memory tests."

"It turns out the locus coeruleus is a really fascinating area to look at in aging because it is the first place that Alzheimer's pathology is seen. And what I mean there is when you hear about Alzheimer's disease, you hear about plaques and tangles and the plaques are amyloid beta pathology and the tangles are related to tau pathology and tau pathology starts in the brain quite a bit earlier than the amyloid."

"I think that Alzheimer's is more like cardiovascular disease. It's a spectrum and we're all somewhere on this spectrum. We all have a little bit of the disease pathology the way that we probably all have some atherosclerosis lurking somewhere in our cardiovascular system. What this means is that, Alzheimer’s is this very slow-moving process and what we really want to be doing is slowing it down."

"That high arousal state is helping you to learn new things and shape your brain and keep your brain plastic as you get older or throughout life. But those high energy, high metabolic brain plasticity processes are creating waste, they're producing things like amyloid and tau. So you've got these positive aspects that leads to brain plasticity, but it also can lead to more pathology."

"You need both the high arousal, sympathetic nervous system, properties that allow for brain plasticity. And you also need these relaxation, parasympathetic properties that allow for things to be repaired and for waste to be cleared out. And you need to go through both of those states every day pretty much to maintain a healthy balance of both really high performance and dealing with the consequences of having had all that brain activity."

"And so my hope and my ambition is to try to figure out the balance where you can engage the brain in intense mental stimulation that leads to growth and neuroplasticity. And we can also figure out optimal ways to either restore deep sleep and enhance that or do these sort of meditative or heart rate variability, biofeedback sort of practices that can mimic some of the aspects of deep sleep and allow for the clearance of the waste products of that really high mental stimulation."

"One study that looked at a large sample of people who have practiced meditation for many years versus people who have not practiced meditation found that when they just used a machine learning technique to guess at how old the brains were of each person. This algorithm guessed that on average, the meditators brains were 7.5 years younger than their actual age and compared to the control brains, which were non-meditators and didn't show that effect. So it seems that meditation is associated with benefits for the actual brain health, which is really interesting, whether this might be because over years, they've had better clearance of these potentially pathological aspects that when they accumulate for many years eventually lead to Alzheimer's disease."

Learn more about Professor Mara Mather and her work at https://gero.usc.edu/faculty/mather/

Bérénice Benayoun, Assistant Professor of Gerontology at the USC Leonard Davis School of Gerontology, is advancing what we know about how cells age, and how they can possibly be returned to a more youthful state, by focusing on areas that have historically been overlooked.

Quotes from this episode: 

The reason it's so powerful is because we can recapitulate most of what you expect from aging in that short amount of time, including cognitive decline, increased amount of cancers, decreased fertility and all of that.

And, it's not that they're dying of like something random. They are dying of aging. When we look at all the signs, they have all the signs of aging, which means we can recapitulate an entire human lifespan in less than six months. And so, that's very attractive to study aging — diseases of aging — as a model. 

One of the problems is they can integrate themselves in genes that are important for cell health, including tumor suppressor genes. And so, when they go everywhere, they're going to create that increasing mutational load, and they can actually drive tumor genesis, right, by turning off the safeguards against uncontrolled cell proliferation. That's one thing. The other thing is, they look exactly like viruses as far as our immune system is concerned. They used to be viruses. And so, when our immune system sees a transposon being expressed, it actually activates and tries to kill it.

Maybe, part of the problem with aging is we have sort of an autoimmune response against those viruses, and we know that sustained immune response — which is, you know, this inflammatory response — is actually very bad for us.

At least in immune cell types, aging creates many more changes in female cells than in male cells. That could explain a lot of the differences in immune diseases. Young women are much more subject to autoimmune diseases, like lupus. It's a frequency of nine to one for women to men, but that decreases after menopause, right? So again, there's a huge interplay between hormones and immunity and immune cell types. We see that aging creates many more changes in females than in males. 

Most people actually just study males, and we know very little about differential mechanisms, and not just with aging, it's across fields. All of these people usually just study males, whether human or mouse because it's simpler.

We're studying aspects of immunity, and we're actually saying that the immune response is vastly different depending on where those mice are in their hormonal cycle. And so, you know, yes, the data, it looks noisy, but if you're actually stratifying it by the hormonal status, it's not more noisy, and it gives you more information.

Learn more about Professor Bérénice Benayoun and her work at https://gero.usc.edu/faculty/berenice-benayoun-phd/.

Dana Goldman, USC Distinguished Professor in public policy, pharmacy, and economics and director of the Schaeffer Center for Health Policy & Economics at the USC Price School of Public Policy, is working to improve health – and reduce spending - by calling for policy changes that reward prevention, innovation and long-term investments in people of all ages.

“I'm a little concerned that in the current debate, we tend to focus mainly on costs and insurance. And the questions around aging are much broader and more dynamic than the current policy debate gives it attention.”

“There's a very good drug, for example, that's under development … it reduces cancer, reduces cardiovascular disease, may be protective for all Alzheimer's, helps with diabetes. And that drug is called exercise. And we've done a lot of research on it, and we know it's very good, but there's no incentive for anyone in our healthcare system to take older people for a walk. And yet, we know that would be extremely valuable.” 

“If I develop a pill, I have a patent system that gives me some protection. And if I take the risk to figure out some way to get this to patients, I know that someone can't copy it until my patent has expired. And that has encouraged the development of a lot of pills. But if I come up with a way to get you to walk or eat better or something like that, it's very easy for someone to copy that. And so you can see that the playing field is tilted more towards treatment and less away from prevention just because of the way we think about intellectual property.”

“Historically, the way we've paid for health care is we paid dollars for volume of services. So you have an office visit, you get paid. And the system has responded by giving us lots of volume of healthcare services. But that's not actually what people want. I mean, they aren't looking to go to the doctor every week. What we really want as a society is good health.” 

“We need to pay for health, not health care. And if we do that, then we'll be able to accumulate some savings out of the system that I think would help pay for all the other types of infrastructure investments that would make sure that people lead wholesome, long, productive lives.” 

Learn more about Professor Goldman and his work at https://priceschool.usc.edu/people/dana-goldman/.

Christian Pike, Professor of Gerontology at the USC Leonard Davis School of Gerontology, discusses his research on sex differences in Alzheimer’s disease and how they can help inform how we might one day prevent and treat it.

Quotes from this episode

… Maybe there are situations where the disease, although it’s the same disease, it works a little bit different in men than it does women. And maybe we should consider that in terms of the risk factors for developing it and even how we approach it therapeutically.

If you look at clinical trials of Alzheimer’s disease drugs, almost all of them are failed.

You can’t control your genetics. At least you can’t yet. But you can control your environment and your lifestyle what we call modifiable risk factors. And so what everybody can do is deal with those now. while we’re, while we’re waiting to get the treatments.

There are so many differences between men and women in Alzheimer’s disease. I mean, at the core of it, the disease is very much the same across all people. But then when you begin to break it down into the effects of different risk factors, you begin to see significant differences.

And in recent years there’s been a greater emphasis on sex differences in the more we look, the more differences between the male brain and the female brain that we find.

Learn more about Professor Pike and his work at https://gero.usc.edu/faculty/pike/

Dr. Laura Mosqueda, Dean and Professor at the Keck School of Medicine of USC, is raising awareness about the issue of elder abuse and shaping how it is addressed in medical schools, clinics and the national conversation.

 Quotes from this episode

“Whenever an older adult comes into an emergency room or a primary care office with some sort of injury or wound, we almost always can find a reason other than abuse or neglect that it happens. So, we don't want to overcall it and over-accuse people, but we need to be aware that it's a possibility.”

“Well, I think one of the important things as a primary care physician is that we do take a holistic approach to things, so that sometimes I joke around with my patients and I say, well, your cardiologist's job is to pay attention to your heart, and my job is to make sure that we remember the heart is attached to the rest of you, and how are we going to take care of your heart in the context of you. And then, even as importantly, in the context of your family and your social situation.”

“There's remarkable work being done to help caregivers and this idea of caregiver stress, it's so important for caregivers who are under stress to recognize that within themselves, to not feel embarrassed or ashamed, and to reach out and accept help, which is very hard for a lot of us to do.”

"One of my big jokes is nobody has ever thanked me for preventing their fall. If you go into oncology, it's a very heroic sort of specialty, and cardio thoracic surgery is very heroic. Geriatrics is not what you think of when you think of a heroic specialty. So it just doesn't have the same kind of oomph and excitement that other specialties do. But once you get in there, and you do some house calls, and you meet people who are 90 or 100 years old and hear their stories. For me, that's very inspiring."

Learn more about Dean Mosqueda and her work at keck.usc.edu/faculty-search/laura-mosqueda/

USC University Professor Caleb Finch is working to understand the relationships between aging, genes and the environment through his studies of ancient mummies and premodern societies.

Quotes from this episode

How people in ancient times may have had heart disease, currently the world’s leading cause of death: 

“The oldest individual may be the Tyrolean iceman, Ötzi, as he's called, who is... 3000 BC, living in the Copper Age. And, both of his carotid arteries were calcified. He died because of a wound from a weapon. But, I think it's a conclusion that's fairly robust. Is that they're, at least in the last 10,000 years in the Neolithic area era, people have had some level of atherosclerosis. Although, it may not have been a major cause of death or disability.” 

On the paradox of how the Tsimane population lives with high levels of inflammation but low levels of heart disease, even at older ages:

“So, what has turned out to my cardiologist's surprise, when they actually started imaging the older Tsimane that they have almost no vascular disease, and stroke and heart attack are very rare causes of death. They're mostly...death is caused by infections, or associated with infections. And, it's a wonderful mystery as to how the rate of blood vessel aging is so much slower in this population than in North America and Western Europe. So we're studying this in terms of diet, in terms of stress, in terms of disease load, and, of course, we are looking at their individual genetics. … And, that's why the Tsimane project is so fascinating because they have lifelong high inflammation, and we all would have predicted and did that they would have had faster aging for these same diseases. But it's not the case, at least for that heart disease.”

On the surprises that come with scientific research

“So, that's one of the great pleasures in science. As you put your best thoughts together and let them be challenged, looking at different varieties of lifestyle and it turns up that there are things that seem paradoxical that give deeper insights into basic mechanisms of aging.”

Learn more about Professor Finch and his work at gero.usc.edu/faculty/finch

Inspired by a mentor’s extreme experiments with caloric restriction, USC Leonard Davis School of Gerontology Professor Valter Longo explores how fasting-mimicking diets might help prevent disease, promote healthy aging, and prolong our ability to stay young.

Quotes from this episode

Longo’s ambitious goal for human longevity

“I want to optimize the chance for people to make it to 110 healthy. That's it. So, to make it to 110 healthy, you have to solve it all, and it's a very ambitious plan. And of course if you get cancer or you get diabetes or you get Alzheimer's, that's not going to happen. So then the focus, of course, is on healthy longevity for the sake of reaching that goal.”

On accepting that most drastic dietary changes don’t stick for the long term

“The reality is 90 percent of people are never going to change what they eat. Neither the quantities, nor the type. They may make small changes, but they're not going to make big changes in the long run. They could make big changes for six months, for 12 months and then they'd go back. That's a reality, right? We have a million studies showing that. So then people should start dealing with that reality.”

Fasting means different things to different people and needs to be undertaken carefully

“I always say that fasting doesn't really mean anything. Fasting is like saying eating. As we all know now if you say, ‘Oh, is eating good for you?’ Well, yes and no. So it can be very good or very bad. It depends what you eat, and fasting is the same way. It can be very good or very bad, depending on what you do, how long you do it for, who you are, etc. So, we'd been trying to move away from words that don't mean anything, like intermittent fasting, and really started saying, ‘Pay attention, be careful,’ because fasting-based intervention can be very powerful or very damaging.”

The enormous potential of food to prevent and address disease

“There is nothing that even comes close to the benefit that we will have for almost nothing, free or close to free, by changing food habits. And it could be revolutionary.”

Learn more about Professor Longo and his work at gero.usc.edu/faculty/longo.

Demographer and USC University Professor Eileen Crimmins researches how and why American lifespans are now falling short of those in other wealthy nations and what the science of biomarkers can tell us about healthy aging. 

Quotes from this episode

On the U.S.’s slide in life expectancy:

“Over the last century, the US gained markedly in life expectancy and practically doubled from approximately 40 to approximately 80. And, the US was a relative leader in that up until maybe later part of the last century. … But now we're down with states that were once part of Russia, Cuba, Chile. We're below many of those states even now. So, the US, in life expectancy, has really fallen behind everyone, the people we think that should be our peers.”

The decline in average life expectancy appears to be largely due to more death at middle ages:

“We know a significant part of it is not due to old age mortality. It's due to middle age … the most recent change has been the opioid epidemic. At the oldest ages, we still are a leader in life expectancy. So, above age 74 or five, something like that, we are one of the top countries in life expectancy. So, there's quite a bit of difference between getting old and being old in this country. It's a country where we're less likely to have people get old, but once we get to the point where we are old, we do pretty well.”

How improvements in treating chronic diseases have impacted lifespan and healthspan: 

“In the last century when life expectancy increased, it was because babies and children survived. When they survived, they survived infectious conditions. … When older people started being the source of gains in life expectancy, they came primarily from declines in heart disease, but it wasn't because we were preventing people from getting heart disease. People were living with treated heart disease, and people were being prevented from dying.”

The ways in which adverse childhood experiences, such as abuse, hunger, and stress, can affect health later in life:

“As time has gone on, more and more people have identified early life as having a variety of pathways that affect later life. … [Adverse childhood experiences] appear to have an early effect on epigenetics related to inflammation, which sets in motion things that affect your responses to bacteria and to viruses. … If it's set in motion early in life, then it's something you're constantly using to react to the world throughout life.”

Learn more about Professor Crimmins and her work at gero.usc.edu/faculty/crimmins.

Join experts on aging from the University of Southern California for a podcast about the science -- and scientists -- improving how long and how well we live. Learn more at lifespanhealth.usc.edu.