How can patients improve their lifespan?

How Patients Can Improve Their Lifespan

The most effective strategies to improve lifespan involve addressing modifiable lifestyle factors, managing chronic diseases through evidence-based treatments, and reducing socioeconomic disparities—with behavioral changes potentially adding years of life even without major scientific breakthroughs. 1

Evidence-Based Lifestyle Modifications

Primary Prevention Strategies

• Behavioral and lifestyle changes represent the most accessible pathway to lifespan extension, as significant improvements in health and life expectancy could be achieved by reaching the levels already demonstrated in peer societies through policy and individual action 1
• Addressing socioeconomic disparities is critical, as these factors directly correlate with the burden of cardiovascular and non-cardiovascular conditions that shorten lifespan 2
• Regular physical activity, particularly maintaining locomotion capacity, is a key predictor of disability- and dementia-free survival extending 12 years 3

Specific Modifiable Risk Factors

• Cardiovascular risk factor management is essential, as cardiovascular disease disproportionately affects older adults and current prevention approaches have already extended survival 4
• Blood pressure control targeting <135/80 mmHg long-term helps prevent progression of vascular disease 5
• Maintaining cognitive function through education and mental stimulation predicts longer healthy longevity 3
• Visual acuity preservation is independently associated with extended disability-free survival 3

Chronic Disease Management

Optimizing Treatment of Existing Conditions

• Patients with chronic diseases can extend lifespan through appropriate disease-modifying treatments, though this has paradoxically increased disease prevalence by extending life for those with illness 1
• For patients with type 2 diabetes, metformin therapy helps control blood sugar and may extend lifespan when used appropriately, though it requires monitoring of kidney function (eGFR) at least annually 6
• Patients with cardiovascular disease benefit from comprehensive management that includes assessment of frailty, multimorbidity, depression, quality of life, and cognition—factors that are prognostically important but seldom formally evaluated 4

Important Treatment Considerations

• Avoid metformin in patients with eGFR <30 mL/min/1.73 m² and do not initiate in those with eGFR 30-45 mL/min/1.73 m² due to increased risk of lactic acidosis 6
• Patients should limit alcohol intake while on metformin, as alcohol potentiates effects on lactate metabolism and increases lactic acidosis risk 6
• Temporary discontinuation of certain medications may be necessary during acute illness, dehydration, or procedures with contrast agents 6

Personalized Risk Assessment

Tools for Individual Evaluation

• The Healthy Longevity Index (HLI) provides a practical tool for real-time assessment of 4-, 8-, and 12-year disability- and dementia-free survival probability, with C-statistics of 0.79 demonstrating robust predictive performance 3
• Comprehensive geriatric assessment (CGA) evaluates functional status, comorbidities, polypharmacy, nutritional status, cognitive function, psychological status, and socioeconomic factors to predict functional age beyond chronologic age 2
• Gait speed assessment is associated with survival in older adults and can be easily measured in clinical settings 2

Risk Stratification

• The HLI effectively stratifies patients into risk tertiles, with the highest-risk group showing only 27.8% probability of 12-year healthy survival compared to 87.8% in the lowest-risk group 3
• Key predictors include age, sex, education, and intrinsic capacity impairments in locomotion, visual acuity, and cognition—all assessable during routine consultations 3
• Life expectancy estimation should incorporate demographic variables, self-reported comorbid conditions, and functional measures rather than chronologic age alone 2

Realistic Expectations and Future Directions

Current Limitations

• Life expectancy at birth is unlikely to reach levels above 95 years unless there is a fundamental change in our ability to delay the aging process itself 1
• Compression of morbidity (delaying disease onset relative to lifespan) has not yet been substantially achieved, as the age of onset of most health problems has not increased markedly 1
• While treatment extends life for those with disease, this has increased disease prevalence rather than compressed morbidity 1

Emerging Approaches

• Pharmacological interventions aimed at delaying aging are under investigation, though translating safety and efficacy from animal models to humans remains challenging due to lack of reliable biomarkers 7
• Delaying physiological changes that result in disease and disability ("delaying aging") will be necessary to substantially compress morbidity and increase relative healthspan 1
• Species, sex, and strain confer significant heterogeneity in pharmacological responses, complicating translation to human populations 7

Common Pitfalls to Avoid

• Do not rely solely on chronologic age to estimate life expectancy or treatment benefit—functional status and comorbidities are more predictive 2
• Avoid assuming all older patients are the same; aging phenotypes vary significantly (non-frailty, multimorbid frailty, metabolic frailty, cognitive frailty, functional frailty) and require different management approaches 8
• Do not overlook socioeconomic factors, as these contribute significantly to specific aging patterns and health outcomes 8
• Avoid focusing exclusively on disease treatment without addressing functional capacity, cognition, and quality of life measures 4