How would you like to be in your last 10 years? Independent and mobile, with loads of energy and no chronic illnesses, or sickly, tired and fatigued while confined to a wheelchair or bed?” asks Dr Nuraini Amalina Binti Mujahid of geroscience health and wellness centre Regenosis in response to the question of what longevity means to her—getting right to the crux of the medical conversation around the future of ageing. Sure, there are supplements, exercises and an array of resorts that purport to help people extend their lives, but it is no longer about just living to a ripe old age; the focus has increasingly shifted to increasing lifespan as well as health span—the number of years a person can expect to live in generally good health, free of chronic illnesses and cognitive decline.
Enter geroscience, which delves deep into the biology of ageing and how retarding it can postpone or prevent the onset, or mitigate the severity, of age‐related illnesses, thereby prolonging health span. While it is now taking much more of a front seat than before, given that the over‐60s are the fastest‐growing age group across the globe and that the world in general is now living longer, the discipline is not new. The call to research into ageing was first made more than a century ago, in 1903 by Russian microbiologist and Nobel laureate Elie Metchnikoff. Then a professor at the Pasteur Institute in Paris, the founder of longevity science coined the term “gerontology”—a comprehensive, systematic and multidisciplinary study of ageing; with his pioneering research into gut microbiome and how it can enhance health as well as prolong life showing the way forward.
While an ageing population is a global trend (the World Health Organisation predicts that the number of people aged 60 and above worldwide will double to 2.1 billion by 2050, with those aged 80 or older reaching 426 million), some countries experience it at a much faster pace than others. Singapore, for one, faces a rapidly ageing population—according to the Department of Statistics Singapore, almost one in four Singaporeans will be aged 65 and above by 2030. The average life expectancy in Singapore stands at 83.5 years as of 2021 and is projected, according to a study by the University of Washington’s Institute of Health Metrics and Evaluation, to reach 85.4 years in 2040. The problem is, there seems to be no corresponding uptick in the quality of life, health‐wise, for seniors here—which can translate into increased pressure on the healthcare sector and costs to the economy, among other things. Consider the worrying statistic from the National Registry of Diseases Office that three in four heart attack patients in 2019 were aged 60 or above, or the number of elderly who have dementia, which, according to the Ministry of Health, is an estimated 92,000 in 2021, and is projected to hit 152,000 by 2030 and 187,000 by 2050. Taken together, these paint a not‐too‐rosy picture of how one’s latter years could be.
What geroscience promises, then, is particularly appealing. But can it really deliver on its potential to transform how we live out our golden years?
Signs of Your Time
According to Dr Andrea Maier, a longevity medicine physician and the co‐director of the Centre for Healthy Longevity (CHL), a multidisciplinary hub at Alexandra Hospital, as well as the Healthy Longevity Translational Research Programme at Yong Loo Lin School of Medicine at the National University of Singapore (NUS), ageing is a disease that happens the minute we are conceived in the womb. To be exact, “ageing happens whenever a cellular action is performed”, says Dr Maier, who is also an Oon Chiew Seng Professor in Medicine, Healthy Ageing and Dementia Research at NUS. “And you’re constantly using your body, no matter what action you’re doing; this causes damage to accumulate.”
The goal of geroscience is not to reverse said damage or eradicate it. Neither is it a cure for diseases such as cancer, which research suggests may be imprinted into our genes, or a longevity solution. Rather, it is about solving issues that happen when time and damage are involved, with Dr Nuraini Amalina adding that the discipline also factors in an individual’s genes, which account for about 20 per cent of the ageing process (environmental and lifestyle factors contribute the rest), when it comes to determining which diseases or disabilities will develop. “Geroscience,” she expounds, “is the study of integrating the biology of ageing with age‐related diseases [that] decrease health span and lifespan … It’s about helping cells to age slowly and healthily so that you can live a life with a good health span. A good health span will naturally increase the lifespan and hence, induce longevity.”
Dr Nuraini Amalina further explains that apart from genetics, there are three main causes of ageing: the environments we live in (think pollution, radiation, pesticides, et cetera); our lifestyles (increasingly stressful and leading to unhealthy behaviours such as smoking and a lack of sleep or exercise); and existing diseases and their treatment (for instance, cancer and chemotherapy). Are these unique to Singapore? Dr Maier thinks not, positing that there are common denominators across the globe when it comes to factors that can accelerate ageing—an example being one’s diet, which, a study has shown, when optimised, even at age 60, could add eight years to a woman’s life.
In a local context, though, Dr Maier stresses that the one thing we should really be doing is manage our stress levels. According to the 2022 360 Global Well‐being Survey conducted by global health service provider Cigna, 86 per cent of adults in Singapore are stressed—well above the global average of 82 per cent. That said, she lets on that Singapore is actually at the forefront of innovation in geroscience and is considered one of the best places in the world to conduct research. Correspondingly, “everything a patient receives at CHL’s longevity clinic is based on global research and studies, but of course, we also make sure to include local versions, because genetics, environment and lifestyle habits matter, and contextualise the global ones. It’s about bringing the ‘best of’ to Singapore and making it the finest here.” So how can one leverage this environment to live out the winter of life with vitality?
Act, Not React
For one, rather than a curative approach to healthcare, take a preventive stance and be proactive instead of reactive. “Presently, treatments are emphasised on the diseases themselves, not the cause. We treat hypertension, diabetes, obesity and cardiovascular disease after they have developed, [but] since they’re all age‐related, what we should be looking at instead is ageing and how to control it,” says Dr Nuraini Amalina. In that sense, geroscience is the means through which you can take back the reins of how you want to age—and die.
And you don’t have to wait till you’re older to fight getting old. The beauty of the geroscience approach is that the extrinsic factors that can affect the biological mechanisms of ageing—some of which may be unique to an individual and are usually identified by physicians upon first consultation—can serve as targets for intervention at any age. At both CHL and Regenosis, for example, physicians will first consult with you to find out how your body is currently functioning. This involves asking a series of lifestyle questions as well as collecting blood, saliva and stool samples to both determine how well different organs in your body are working and predict life expectancy. Both doctors point out that things we may not consider as important as diet and exercise can actually speed up the ageing process. Dr Nuraini Amalina brings up the issue of stress (numerous studies across the years have shown that it accelerates ageing), while Dr Maier regales the tale of asking for sleep data from patients.
A tad concerned about the heavy‐handed implications suggested by the word “intervention”? Rest easy, for it is simply medical terminology for an action taken to improve a medical disorder. One such intervention is Regenosis’ RealHealth, a bespoke six‐month‐long programme tailored to help you change the way you are living so as to be physically, mentally and emotionally fit and less stressed, thereby fulfilling Maslow’s hierarchy of needs—from the basic physiological and safety needs to the social and esteem needs, and the self‐actualisation needs right at the top of the pyramid.
But what of intrinsic factors that modulate the biological mechanisms of ageing, you ask? Specifically, does being born a woman put one at a disadvantage when it comes to ageing? Dr Nuraini Amalina explains: “Despite all else—environmental exposures and lifestyle choices—being equal, there are fundamental differences in some areas due to genetic determinants of sex.” Some noticeable ones are life expectancy (women edge men out by three to five years), brain metabolism (the slowdown with age happens faster for men) and sexual function (menopause causes women to lose oestrogen at a more dramatic rate than testosterone for men when andropause happens).” So no, it does not appear that women drew the short end of the stick when it comes to chromosomes and ageing.
The Future of Ageing
Interestingly, not all who have adopted the geroscience approach are seeking to slow the ageing process. What prompted Cheryl Huang*, for instance, to enrol in Regenosis’ RealHealth programme was the desire to figure out the trigger for her skin allergy. “I have a childhood condition where my skin becomes inflamed and I wanted to find out what exactly triggers it so that the condition wouldn’t worsen as I age,” shares the 33‐year‐old, who adds that she has a well‐balanced lifestyle (“My diet is low in fat and oil, and I don’t drink, smoke or keep late nights.”).
Prior to her engagement with Regenosis, Huang had done multiple allergy prick tests at hospitals, which all came back negative. A DNA test ordered by the specialists tending to her at Regenosis, after discovering through a consultation that her inflammation acted up whenever she ate salty food, ultimately confirmed an allergy to monosodium glutamate (aka MSG). Following the lifestyle interventions prescribed, Huang now has her condition, which affected more than just her skin, completely under control. Apart from a significantly improved complexion, “the biggest change physically is that my body feels more refreshed and I can stay alert for longer hours”, shares Huang, who adds that her stress levels have also dipped because she no longer worries about flare‐ups. “I believe that my diet plays a big part in contributing to this result and I’m happy with my body now because I can even think faster and be more alert at work.”
Given all you now know about geroscience, should you book a consultation at a longevity clinic? Dr Maier thinks that independent of how you physically feel or even think your body is performing, you should go for a check‐up because the greatest asset you have in life is your body. She reasons: “If your body is functioning well, you’ll reap the benefits—you’ll be able to work, meet your friends and be fully mobile. It’s thus very important that we keep it alive and kicking, which is where a visit to a longevity clinic helps. We help you work with what you currently have and make it better. If, for example, you have irreversible damage to one part of your body, geroscience helps by optimising [the other parts] to work even better to cope with the damage of that one part. That’s what’s so wonderful about geroscience.”
*Name has been changed to protect anonymity