Presider:
        Kenneth Kaloustian, Ph.D., Chair of Biomedical Sciences, Quinnipiac College
Other presenters:
        Donald J. Mulcare, Ph.D., Director of Gerontology Programs, Gerontology Center, University of Massachusetts Dartmouth
        Augustine G. DiGiovanna, Ph.D., Professor of Biology, Salisbury University, Salisbury, MD.

Symposium Outline and Page Index
1. Questionnaire about controlling aging: what would/could/should happen?
2.a. Information presented
    Demographics projections
    Potential methods for changing aging, ML, XL and improving quality of life
        Diet
        Exercise
        Better diagnosis
        Pharmacy
        Surgery
        Supplements
        Caloric restriction (CR)
        Hormones
        Genetics
2.b. Possible consequences from altering mean longevity, maximum longevity, or both;
    Quality of life
    Increased mean longevity
    Increased maximum longevity
    Changes in demographics
        Statistics
        Possible societal impact
        US
2.c. Possible conclusions.
3. The relevance of offering this type of discussion in gerontology programs.
4. Additional summaries, notes, and bibliographies.
    Hormones and Aging
    Genes and Aging
    Bibliography

CONTROLLING AGING: WHAT WOULD/COULD/SHOULD HAPPEN?

1. Questionnaire about controlling aging: what would/could/should happen?

To investigate knowledge of and opinions regarding how human aging could or should be controlled.

2.a. Information for us to present

Demographics projections

       - How the US Census makes population projections. List the criteria used and the cohort method for population projections.
                    https://www.census.gov/population/www/documentation/twps0038/twps0038.html
            - The US Census makes three different projections; lowest, middle, and highest. The lowest and highest are the OUTSIDE LIMITS of what is "possible" given their minimum and maximum values used in their equations. The middle values are their "best guess" based on their assumptions, including that expected the MLs are in the 80s, and there is no mention of XLs. Given these assumptions and if MLs or XLs are increased, then the US Census highest projections should be considered extremely conservative if not unrealistically low.
                - (1) Making projections is a complex process.
                - (2) Some of the important data and equations are in the US Census Bureau computer and are not accessible by the public.
                - (3) One cannot simply change one number, such as ML, and get answers because each assumption, such as ML, is developed for each small segment of the population (e.g., age, race, national origin, sex), so there are a multitude (a matrix) of numbers used for each year's projections, and the entire matrix changes for each year. The matrix includes assumptions for things like birth rates for different types for females (e.g., age, race), death rates for people of different ages and for different family sizes and different economic status, and more. We are not able to see easily what might happen in real numbers if ML or XL were to change or if death rates for people of different age groups were to change.

        - US projections are now available to the year 2100. Since many people being born now can expect to live almost that long.

       - Many other projections other than total population { e.g.,  geographic distributions, sex ratios, MLs, age distributions and pyramids, available care facilities, health status, diseases, care expenses} are available from the US Census Bureau..

       - Note that projections change as years pass due to changing conditions and assumptions.

Potential methods for changing aging, ML and XL and improving quality of life

     "Intercompensating mortality factors"; i.e., if the major causes of aging and diseases are reduced or eliminated, they will be replaced with other factors so it is futile to try to increase ML or XL significantly.

Why many people would not, even if they could!

    - Affordability
            - Your Money or Your Life
            - The Cost Of Life Extension
            - Retirement Planning Is Tough Enough
            - Outliving One's Pension
            - Work Until You Drop?
    - Diet, Exercise Ignored
    - Obesity & Diabetes
    - Sci/Fi Vision of Extreme Old Age
    - Science Vs. Snake Oil
    - Conspiracy Theory
    - Following The Wrong Advice

Exercise
           - exercise is known the prevent many diseases and to correct many others (e.g., atherosclerosis, heart attacks, strokes, diabetes mellitus, osteoporosis, intestinal diseases (e.g., constipation, diverticulosis)
           - types of exercises needed for a healthy older person are the same as those for a young adult except for modifications in speed, strength, and coordination to compensate for the usual age-related changes in the skeletal, muscle, and nervous systems.
           - Use it or lose it.
           - Use it to improve it.

Pharmacy
     - new and better medications and herbal substances are known that prevent many diseases and to help correct many others (e.g., atherosclerosis, heart attacks, strokes, osteoporosis, intestinal diseases (e.g., constipation, diverticulosis, cancers, cosmetic surgery)

Replacement Cells and Organs

             - tissue transplants and organ transplants are known the prevent some diseases and to help correct others (e.g., brain cells for parkinsonism, pancreatic islet cells for diabetics, bone marrow for leukemia and for marrow- destroying diseases and treatments, hearts, livers, skin graphs, skeletal joints, arteries, hearts, inner ears for hearing, cosmetic prostheses)
           - new and better surgical procedures are known the prevent many diseases and to help correct many others (e.g., atherosclerosis, heart attacks, strokes, osteoporosis, intestinal diseases (e.g., constipation, diverticulosis, cancers, cosmetic surgery)
        - robotics, prosthetics replacement organs hips, knees, skin, blood, hearts, bones
        - immune system modifications
            - cell implants
            - organ transplants and replacement (e.g., human donors, animal donors, organ "cloning)
            - implants for the brain  (e.g., dopamine, acetylcholine, embryo brain parts)

Vitamins and minerals
                - except for vitamin E, supplements help only by augmenting a poor diet or compensating for a disease condition (e.g., intestinal, kidney)
                - vitamin E serves and an antioxidant, which seems to help prevent atherosclerosis, heart attacks, and strokes

Antioxidants (synthetic, organic)
              - antioxidants other than vitamin E reduce certain age changes in animal experiments but have not been shown consistently to increase ML or XL
              - oxidants are necessary as useful entities (e.g., neuronal signals, hormonal signals, WBC and immune defense responses).
              - there is inadequate knowledge about which FRs are dangerous and how to specify antioxidant therapy

Caloric restriction (CR)
           - definition in humans vs ad lib
           - CR is know to increase ML and reduce diseases in many animals including monkeys (e.g., cancers, diabetes mellitus)
           - compliance with CR may be difficult. Note preponderance of overweight and obesity now.
           - would it be possible to use anti-appetite drugs to suppress hunger (possible abuse)
           - CR may have adverse effects on quality of life (e.g., constant hunger, limited energy expenditures (e.g., work, recreation), poor concentration, altered behaviors and personality traits, poorer healing, reduced tolerance of and recovery from serious illness (i.e., lower body reserves)
        - For detailed notes click here.

         Go to Hormones and Aging

                 - hormone supplements have been shown to slow or reverse some age changes and some diseases. However, research shows significant adverse side effects. Hormone supplementation is not yet known to alter ML or XL. Some hormones (e.g., melatonin, DHEA) are not regulated in any way (e.g., production, availability, doses)
             - GH improves muscle and bone and skin but may promote diabetes mellitus and cancers. Exercise helps maintain GH levels and also promotes all the benefits of GH supplements without the drawbacks.
             - Melatonin is a potent antioxidant but also affects biorhythms (e.g., sleep:wakefulness), including rhythms of other hormones (e.g., ADH, glucocorticoids). Some sources of melatonin are contaminated with toxic materials and are unregulated.
             - The normal functions of DHEA are unknown. DHEA may reduce some diseases, but results are inconclusive and controversial. DHEA supplementation produces dangerous by-products.
             - Estrogen reduces some age changes (e.g., bone loss, memory loss) and some diseases (e.g., atherosclerosis, heart attacks, strokes, Alzheimer's) but has adverse side effects for some women (e.g., cancers, blood clots)

        Go to Genes and Aging

        - (e.g., gene therapy, transgenes from non-humans, man-made genes, telomerase)
        - genetic engineering works in animals (e.g., selective breeding, altering genes, "designer" genes from humans, synthetic genes, transgenes from non- humans,))
         - additional effects while altering ML and XL are not well studied or documented
         - correct congenital defects
         - correct late life defects
         - enhance vitality.

2.b. Possible consequences from altering mean longevity, maximum longevity, or both;

    Should we? Is It Worth The Cost?
            - Species Approach applied to humans (Ethical Cost)
            - Health Resources Needed Elsewhere
            - No Guarantee That Later Years Would Be Better
            - Harvard Study: (East Boston) 47% of >85 Apparent SDAT
        There Is More To Life That This?
            - Spiritual Dimension
            - Patrick Henry

Quality of life

There are different criteria used to establish quality of life.
       - physical independence, medical status, economic status, social status and situation, life satisfaction, self-efficacy, self-determination

Increased mean longevity
   - with or without increasing quality of later life

Increased maximum longevity
   - with or without increasing quality of later life

Changes in demographics
    Graphs of demographics
        Projected U.S. Population  - 2000-2100
        Elders as Percent of Population - 2000-2100 (Middle Series)
        Projected Life Expectancies at Birth - 1995-2050
        Projected Life Expectancies at Age 65 - 1995-2050
        Life Expectancies - 2000-2100
        Survival Curves 1999-2100
        Percent Female Elders 65+ - 2000-2100
        Population Ages 25-64 by State - 1995-2025
        Population Ages 65+ by State - 1995-2025
    Web Sites for demographic data and graphs
       One of the most complete sources with very diverse types of data, table, and wonderful graphs is
            "The Population 65 Years and Older in the United States: 2016" at
              https://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-38.pdf
        Other good ones are at
           https://www.aoa.dhhs.gov/aoa/stats/aging21/default.htm
           https://www.aoa.dhhs.gov/aoa/stats/statpage.html
           https://www.census.gov/prod/1/pop/p25-1130/
           https://www.census.gov/population/www/projections/popproj.html
                Life Tables
                  https://www2.census.gov/library/publications/2010/compendia/statab/129ed/tables/10s0105.xls
 
Statistics
   - size of U.S. population
        https://www.census.gov/prod/1/pop/p25-1130/
        https://www.census.gov/population/www/projections/natsum-T3.html
        https://www.census.gov/population/projections/nation/summary/np-t1.txt
        https://www.census.gov/population/www/projections/natsum.html
        https://www.census.gov/population/www/projections/natdet-D1A.html
   - size of global population
        https://www.census.gov/ipc/www/
   - age distributions and age pyramids
        https://www.census.gov/population/www/projections/natchart.html
   - geographic distribution of elders
        https://www.census.gov/population/www/socdemo/age.html#elderly
   - health status of population
        https://www.cdc.gov/nchs/agingact.htm
        https://www.cdc.gov/nchs/products/pubs/pubd/hus/hus.htm

Possible societal impact from demographic changes (i.e., changes in groups)

Note the projections about HMOs and the cost of health care, Social Security, prescription drugs.

US

     International
          - Global conditions
          - International politics

2.c. Possible conclusions.

3. The relevance of offering this type of discussion in gerontology programs.

    1. Show students ethical implications of altering ML or XL.
    2. Shows interdisciplinary aspects and therefore need for interdisciplinary education for gerontology students. Wouldn't this be a great class discussion in any gerontology course regardless of its special focus (e.g., sociology, psychology, economics, biology, philosophy, etc.).
    3. Provide opportunities for students to progress up Bloom's categories (i.e., knowledge, {name, define, list, describe}; comprehension {explain, interpret, predict, summarize}; application {apply, modify, construct}; analysis {show how or why something relates or works}; synthesis {design an experiment or study, make predictions, use data to support a position}; evaluation {compare and contrast, decide, select the best})
    4. Allows students with different backgrounds, value systems, and backgrounds to contribute and to appreciate the contributions and perspectives of others.
    5. Contributes to more expansive thinking by faculty teaching courses.
    6. Shows need for VERY long range thinking about outcomes from short range changes (e.g., "small" increase in ML and how that could make MAJOR differences within one's lifetime and certainly within the lifetimes of ones children - many college-age folks plan to have children within a few years of their graduation.)
    7. Show students opportunities for and importance of continued research.
    8. Show students importance of being educated about gerontology to be educated citizens and career professionals prepared to address inevitable questions about altering aging and its outcomes.

4. Summaries, notes, and bibliographies with current references about what would/could/should happen regarding controlling human aging.

(no author): "Births, Marriages, Divorces, and Deaths for November 1996." Monthly Vital Statistics Report, U.S. Department of Health and Human Services 45(11) May 15 (1997).

(no author): "Births, Marriages, Divorces, and Deaths for November 1997." Monthly Vital Statistics Report, U.S. Department of Health and Human Services, 4(12) July 28 (1998).

(no author): "Historical Statistics of the United States: Colonial Times to 1970: Part 1." U.S. Department of Commerce, September (1975).

(no author): "Resident Population of the United States: Estimates, by Age and Sex." U.S. Bureau of the Census, August 28 (1998).

(no author): "Sixty-five Plus in the United States." U.S. Census Bureau: the Official Statistics Economics and Statistics Administration, U.S. Department of Commerce, May (1995).

(no author): "Statistical Abstract of the United States 1997." The National Data Book, 117th Edition, U.S. Department of Commerce, October (1997).

(no author): "Trends in the Health of Older Americans: United States, 1994." Vital and Health Statistics, U.S. Department of Health and Human Services, Series 3: Analytic and Epidemiological Studies No. 30, DHHS Publication No. (PHS) 95-1414 April (1995).

Arking R: "Biology of Aging: Observations and Principles." Prentice Hall, Englewood Cliffs, NJ (1999).

Austad SN: "Why We Age: What Science Is Discovering about the Body's Journey Through Life." John Wiley & Sons, Inc., NY (1997).

Carter WR: A Means to an End: The Biological Basis of Aging and Death." Oxford University Press, NY (1999)

Comfort A: The Biology of Senescence.(Third Edition),New York:Elsevier (1979).

DiGiovanna AG: "Human Aging: Biological Perspectives." McGraw-Hill, NY (2000).

Diplock AT: "Will the 'good fairies' please prove to us that vitamin E lessens human degenerative disease?." Free Radic Res (1997) Nov;27(5):511-532.

Gardner P, Rosenberg HM: "Leading Causes of Death by Age, Sex, Race, and Hispanic Origin: United States, 1992." Vital and Health Statistics Series 20: Data on Mortality, No. 29 U.S. Department of Health and Human Services DHHS Publication No. (PHS) 96-1857 June (1996).

Hayflick L: "How and Why We Age." Ballantine Books, NY (1994).

Kilama: WL:  HEALTH CHALLENGES EARLY IN TWENTY FIRST CENTURY SUB-SAHARAN AFRICA, LECTURE  DELIVERED AT THE 19TH AFRICAN HEALTH SCIENCES CONGRESS INCORPORATING THE 16TH AJSC, NIMR, TANZANIA ARUSHA 15 APRIL (1998)

Klemera P, Doubal S: "Human mortality at very advanced age might be constant." Mechanisms of Ageing and Development (1997) Nov;98(2):167-176.

Kurian GT: "Datapedia of the United States 1790-2000 America Year by Year" Bernan Press, Lanham, MD (1994).

Lane MA, Ingram DJ, Roth GS: "Beyond the rodent model: calorie restriction in rhesus monkeys." Age (1997) 20:39-50.

Lundh U, Nolan M: "Aging and quality of life. 1: Towards a better understanding." British Journal of Nursing (1996) Nov 14;5(20):1248-1251.

O'Boyle CA : "Measuring the quality of later life." Philos Trans R Soc Lond B Biol Sci. (1997) Dec 29;352(1363) 1871-9.

Olshansky SJ, Carnes BA: "Ever since Gompertz." Demography (1997) Feb;34(1):1-15.

Pickle LW, Mungiole M, Jones GK, White AA: "Atlas of United States Mortality." U.S. Department of Health and Human Services, DHHS Publication No. (PHS) 97-1015 December (1996).

Rowe JW, Kahn RL: "Successful aging." Gerontologist (1997) Aug;37(4):433-440.

Rowe JW, Kahn RL: "Successful Aging." Pantheon Books, NY (1998).

Thurman JE, Mooradian AD: "Vitamin supplementation therapy in the elderly." Drugs and Aging (1997) Dec;11(6):433-449.

Vita AJ, Terry RB, Hubert HB, Fries JF: "Aging, health risks, and cumulative disability." New England Journal of Medicine (1998) Apr 9;338(15):1035-1041.

Ward JA: "Should antioxidant vitamins be routinely recommended for older people?." Drugs and Aging (1998) Mar;12(3):169-175.

Weindruch R, Walford, RL: "The retardation of aging and disease by dietary restriction." Charles C. Thomas, Springfield, IL, (1998).

Weindruch R: "Caloric restriction and aging." Scientific American (1996) Jan 46-52.

Wickens A:  The Causes of Aging. Amsterdam: Harwood Academic Publishers (1998).

 65+ in the United States - U.S. Census Bureau
 https://www.census.gov/prod/1/pop/p23-190/p23-190.html

  Administration on Aging
 https://pr.aoa.dhhs.gov/aoa/stats/statpage.html
       Statistics pages

 Centers for Disease Control and Prevention (CDC)
 https://www.cdc.gov/epo/prevent.htm
  Prevention and cost estimates of diseases

 National Center for Health Statistics
 https://www.cdc.gov/nchs/

 U.S. Census Bureau
 https://www.census.gov/

 International statistics - U.S. Census Bureau
 https://www.census.gov/ipc/www/

Mortality statistics - National Center for Health Statistics
https://www.cdc.gov/nchs/about/major/dvs/mortdata.htm

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