Tag Archives: elderhood

The Dying Algorithm

CREDIT: NYT Article on the Dying Algorithm

This Cat Sensed Death. What if Computers Could, Too
By Siddhartha Mukherjee
Jan. 3, 2018

Of the many small humiliations heaped on a young oncologist in his final year of fellowship, perhaps this one carried the oddest bite: A 2-year-old black-and-white cat named Oscar was apparently better than most doctors at predicting when a terminally ill patient was about to die. The story appeared, astonishingly, in The New England Journal of Medicine in the summer of 2007. Adopted as a kitten by the medical staff, Oscar reigned over one floor of the Steere House nursing home in Rhode Island. When the cat would sniff the air, crane his neck and curl up next to a man or woman, it was a sure sign of impending demise. The doctors would call the families to come in for their last visit. Over the course of several years, the cat had curled up next to 50 patients. Every one of them died shortly thereafter.
No one knows how the cat acquired his formidable death-sniffing skills. Perhaps Oscar’s nose learned to detect some unique whiff of death — chemicals released by dying cells, say. Perhaps there were other inscrutable signs. I didn’t quite believe it at first, but Oscar’s acumen was corroborated by other physicians who witnessed the prophetic cat in action. As the author of the article wrote: “No one dies on the third floor unless Oscar pays a visit and stays awhile.”
The story carried a particular resonance for me that summer, for I had been treating S., a 32-year-old plumber with esophageal cancer. He had responded well to chemotherapy and radiation, and we had surgically resected his esophagus, leaving no detectable trace of malignancy in his body. One afternoon, a few weeks after his treatment had been completed, I cautiously broached the topic of end-of-life care. We were going for a cure, of course, I told S., but there was always the small possibility of a relapse. He had a young wife and two children, and a mother who had brought him weekly to the chemo suite. Perhaps, I suggested, he might have a frank conversation with his family about his goals?

But S. demurred. He was regaining strength week by week. The conversation was bound to be “a bummah,” as he put it in his distinct Boston accent. His spirits were up. The cancer was out. Why rain on his celebration? I agreed reluctantly; it was unlikely that the cancer would return.

When the relapse appeared, it was a full-on deluge. Two months after he left the hospital, S. returned to see me with sprays of metastasis in his liver, his lungs and, unusually, in his bones. The pain from these lesions was so terrifying that only the highest doses of painkilling drugs would treat it, and S. spent the last weeks of his life in a state bordering on coma, unable to register the presence of his family around his bed. His mother pleaded with me at first to give him more chemo, then accused me of misleading the family about S.’s prognosis. I held my tongue in shame: Doctors, I knew, have an abysmal track record of predicting which of our patients are going to die. Death is our ultimate black box.

In a survey led by researchers at University College London of over 12,000 prognoses of the life span of terminally ill patients, the hits and misses were wide-ranging. Some doctors predicted deaths accurately. Others underestimated death by nearly three months; yet others overestimated it by an equal magnitude. Even within oncology, there were subcultures of the worst offenders: In one story, likely apocryphal, a leukemia doctor was found instilling chemotherapy into the veins of a man whose I.C.U. monitor said that his heart had long since stopped.

But what if an algorithm could predict death? In late 2016 a graduate student named Anand Avati at Stanford’s computer-science department, along with a small team from the medical school, tried to “teach” an algorithm to identify patients who were very likely to die within a defined time window. “The palliative-care team at the hospital had a challenge,” Avati told me. “How could we find patients who are within three to 12 months of dying?” This window was “the sweet spot of palliative care.” A lead time longer than 12 months can strain limited resources unnecessarily, providing too much, too soon; in contrast, if death came less than three months after the prediction, there would be no real preparatory time for dying — too little, too late. Identifying patients in the narrow, optimal time period, Avati knew, would allow doctors to use medical interventions more appropriately and more humanely. And if the algorithm worked, palliative-care teams would be relieved from having to manually scour charts, hunting for those most likely to benefit.

Avati and his team identified about 200,000 patients who could be studied. The patients had all sorts of illnesses — cancer, neurological diseases, heart and kidney failure. The team’s key insight was to use the hospital’s medical records as a proxy time machine. Say a man died in January 2017. What if you scrolled time back to the “sweet spot of palliative care” — the window between January and October 2016 when care would have been most effective? But to find that spot for a given patient, Avati knew, you’d presumably need to collect and analyze medical information before that window. Could you gather information about this man during this prewindow period that would enable a doctor to predict a demise in that three-to-12-month section of time? And what kinds of inputs might teach such an algorithm to make predictions?
Avati drew on medical information that had already been coded by doctors in the hospital: a patient’s diagnosis, the number of scans ordered, the number of days spent in the hospital, the kinds of procedures done, the medical prescriptions written. The information was admittedly limited — no questionnaires, no conversations, no sniffing of chemicals — but it was objective, and standardized across patients.

These inputs were fed into a so-called deep neural network — a kind of software architecture thus named because it’s thought to loosely mimic the way the brain’s neurons are organized. The task of the algorithm was to adjust the weights and strengths of each piece of information in order to generate a probability score that a given patient would die within three to 12 months.

The “dying algorithm,” as we might call it, digested and absorbed information from nearly 160,000 patients to train itself. Once it had ingested all the data, Avati’s team tested it on the remaining 40,000 patients. The algorithm performed surprisingly well. The false-alarm rate was low: Nine out of 10 patients predicted to die within three to 12 months did die within that window. And 95 percent of patients assigned low probabilities by the program survived longer than 12 months. (The data used by this algorithm can be vastly refined in the future. Lab values, scan results, a doctor’s note or a patient’s own assessment can be added to the mix, enhancing the predictive power.)

So what, exactly, did the algorithm “learn” about the process of dying? And what, in turn, can it teach oncologists? Here is the strange rub of such a deep learning system: It learns, but it cannot tell us why it has learned; it assigns probabilities, but it cannot easily express the reasoning behind the assignment. Like a child who learns to ride a bicycle by trial and error and, asked to articulate the rules that enable bicycle riding, simply shrugs her shoulders and sails away, the algorithm looks vacantly at us when we ask, “Why?” It is, like death, another black box.

Still, when you pry the box open to look at individual cases, you see expected and unexpected patterns. One man assigned a score of 0.946 died within a few months, as predicted. He had had bladder and prostate cancer, had undergone 21 scans, had been hospitalized for 60 days — all of which had been picked up by the algorithm as signs of impending death. But a surprising amount of weight was seemingly put on the fact that scans were made of his spine and that a catheter had been used in his spinal cord — features that I and my colleagues might not have recognized as predictors of dying (an M.R.I. of the spinal cord, I later realized, was most likely signaling cancer in the nervous system — a deadly site for metastasis).
It’s hard for me to read about the “dying algorithm” without thinking about my patient S. If a more sophisticated version of such an algorithm had been available, would I have used it in his case? Absolutely. Might that have enabled the end-of-life conversation S. never had with his family? Yes. But I cannot shake some inherent discomfort with the thought that an algorithm might understand patterns of mortality better than most humans. And why, I kept asking myself, would such a program seem so much more acceptable if it had come wrapped in a black-and-white fur box that, rather than emitting probabilistic outputs, curled up next to us with retracted claws?

Siddhartha Mukherjee is the author of “The Emperor of All Maladies: A Biography of Cancer” and, more recently, “The Gene: An Intimate History.”

Senior concierge services

“Elder concierge”, or senior concierge services, are blossoming as baby boomers age:

CREDIT: New York Times Article on Senior Concierge Services

https://www.forbes.com/sites/robertpearl/2017/06/22/concierge-medicine/amp/

The concierges help their customers complete the relatively mundane activities of everyday life, a way for the semi- and fully retired to continue to work.

Facts of note:
“Around 10,000 people turn 65 every day in the United States, and by 2030, there will be 72 million people over 65 nationwide.
Some 43 million people already provide care to family members — either their own parents or children — according to AARP, and half of them are “sandwich generation” women, ages 40 to 60. All told, they contribute an estimated $470 billion a year in unpaid assistance.”
“elder concierges charge by the hour, anywhere from $30 to $70, or in blocks of time, according to Katharine Giovanni, the director of the International Concierge & Lifestyle Management Network”

Organizations of note:

“One start-up, AgeWell, employs able-bodied older people to assist less able people of the same age, figuring the two will find a social connection that benefits overall health.
The company was founded by Mitch Besser, a doctor whose previous work involved putting H.I.V.-positive women together in mentoring relationships. AgeWell employees come from the same communities as their clients, some of whom are out of reach of medical professionals
until an emergency.”

The National Aging in Place Council, a trade group, is developing a social worker training program with Stony Brook University. It wants to have a dedicated set of social workers at the council, funded by donations, who are able to field calls from seniors and their caretakers, and make referrals to local service providers.
The council already works with volunteers and small businesses in 25 cities to make referrals for things like home repair and remodeling, daily money management and legal issues.”

Village to Village Network, has small businesses and volunteers working on a similar idea: providing older residents and their family or caretakers with referrals to vetted local services.
In the Village to Village Network model, residents pay an annual fee, from about $400 to $700 for individuals and more for households. The organization so far has 25,000 members in 190 member-run communities across the United States, and is forming similar groups overseas as well.”

=========== ARTICLE IS BELOW ============

Baby Boomers Look to Senior Concierge Services to Raise Income
Retiring
By LIZ MOYER MAY 19, 2017

In her 40 years as a photographer in the Denver area, Jill Kaplan did not think she would need her social work degree.
But when it became harder to make a living as a professional photographer, she joined a growing army of part-time workers across the country who help older people living independently, completing household tasks and providing companionship.
Elder concierge, as the industry is known, is a way for the semi- and fully retired to continue to work, and, from a business standpoint, the opportunities look as if they will keep growing. Around 10,000 people turn 65 every day in the United States, and by 2030, there will be 72 million people over 65 nationwide.
Some 43 million people already provide care to family members — either their own parents or children — according to AARP, and half of them are “sandwich generation” women, ages 40 to 60. All told, they contribute an estimated $470 billion a year in unpaid assistance.

Seven years ago, Ms. Kaplan, 63, made the leap, signing up with Denver-based Elder Concierge Services. She makes $25 to $40 an hour for a few days a week of work. She could be driving older clients to doctor’s appointments, playing cards or just acting as an extra set of eyes and ears for family members who aren’t able to be around but worry about their older relatives being isolated and alone. Many baby boomers themselves are attracted to the work because they feel an affinity for the client base.
“It’s very satisfying,” she said of the work, which supplements her photography income. Like others in search of additional money, she could have become an Uber driver but said this offered her a chance to do something “more meaningful.”
“We see a lot of women,” Ms. Kaplan said, “who had raised their families and cared for their parents out there looking for a purpose.”

Concierges are not necessarily social workers by background, and there isn’t a formal licensing program. They carry out tasks or help their customers complete the relatively mundane activities of everyday life, and just need to be able to handle the sometimes physical aspects of the job, like pushing a wheelchair.
Medical care is left to medical professionals. Instead, concierges help out around the house, get their client to appointments, join them for recreation, and run small errands.
While precise statistics are not available for the elder concierge industry, other on-demand industries have flourished, and baby boomers are a fast-growing worker population.
Nancy LeaMond, the AARP’s executive vice president and chief advocacy officer, said: “Everyone assumed the on-demand economy was a millennial thing. But it is really a boomer thing.”
Ms. LeaMond noted that while people like the extra cash, they also appreciate the “extra engagement.”
A variety of companies has sprung up, each fulfilling a different niche in the elder concierge economy.
In some areas, elder concierges charge by the hour, anywhere from $30 to $70, or in blocks of time, according to Katharine Giovanni, the director of the International Concierge & Lifestyle Management Network. Those considering going into the business should have liability insurance, Ms. Giovanni said.

One start-up, AgeWell, employs able-bodied older people to assist less able people of the same age, figuring the two will find a social connection that benefits overall health.
The company was founded by Mitch Besser, a doctor whose previous work involved putting H.I.V.-positive women together in mentoring relationships. AgeWell employees come from the same communities as their clients, some of whom are out of reach of medical professionals until an emergency.
The goal is to provide consistent monitoring to reduce or eliminate full-blown crises. AgeWell began in South Africa but recently got a grant to start a peer-to-peer companionship and wellness program in New York.
Elsewhere, in San Francisco, Justin Lin operates Envoy, a network of stay-at-home parents and part-time workers who accept jobs like grocery delivery, light housework and other tasks that don’t require medical training. Each Envoy employee is matched to a customer, who pays $18 to $20 an hour for the service, on top of a $19 monthly fee.
The inspiration for the company came from Mr. Lin’s work on a start-up called Mamapedia, an online parental wisdom-sharing forum, where he noticed a lot of people talking about the need for family care workers. He decided to start Envoy two years ago, after his own mother died of cancer, leaving him and his father to care for a disabled brother.
The typical Envoy employee works a few hours a week, so it won’t replace the earnings from a full-time job. But it nevertheless involves more interpersonal contact than simply standing behind a store counter.
“It’s not going to pay the rent,” Mr. Lin said. “They want to be flexible but also make a difference.”

Katleen Bouchard, 69, signed up with Envoy three years ago, after retiring from an advertising career. She gets $20 an hour working a handful of hours a week with older clients in her rural community in Sonoma County, Calif. She sees it as a chance to be civic-minded. “It’s very easy to help and be of service,” Ms. Bouchard said.
Companies like AgeWell and Envoy are part of the growing on-demand economy, where flexibility and entrepreneurship have combined to create a new class of workers, said Mary Furlong, a Silicon Valley consultant who specializes in the job market for baby boomers. At the same time, many retirees — as well as those on the cusp of retirement — worry that market volatility may hit their savings.
The extra income from the job, Ms. Furlong said, could help cover unexpected expenses. “You don’t know what the shocks are going to be that interrupt your plan,” she added.
Other organizations are looking to help direct older residents to vetted local service providers.
The National Aging in Place Council, a trade group, is developing a social worker training program with Stony Brook University. It wants to have a dedicated set of social workers at the council, funded by donations, who are able to field calls from seniors and their caretakers, and make referrals to local service providers.
The council already works with volunteers and small businesses in 25 cities to make referrals for things like home repair and remodeling, daily money management and legal issues.
Another group, the Village to Village Network, has small businesses and volunteers working on a similar idea: providing older residents and their family or caretakers with referrals to vetted local services.
In the Village to Village Network model, residents pay an annual fee, from about $400 to $700 for individuals and more for households. The organization so far has 25,000 members in 190 member-run communities across the United States, and is forming similar groups overseas as well.
“We feel like we are creating a new occupation,” said Marty Bell, the National Aging in Place Council’s executive director. “It’s really needed.”
Twitter: @LizMoyer

DeathEd

I recently did a post on “elderhood” ( http://johncreid.com/2017/02/elderhood/ This post is a follow-up to that.

CREDIT:
https://www.nytimes.com/2017/02/18/opinion/sunday/first-sex-ed-then-death-ed.html?emc=edit_th_20170219&nl=todaysheadlines&nlid=44049881

First, Sex Ed. Then Death Ed.

By JESSICA NUTIK ZITTER•FEB. 18, 2017

FIVE years ago, I taught sex education to my daughter Tessa’s class. Last week, I taught death education to my daughter Sasha’s class. In both cases, I didn’t really want to delegate the task. I wanted my daughters and the other children in the class to know about all of the tricky situations that might await them. I didn’t want anyone mincing words or using euphemisms. Also, there was no one else to do it. And in the case of death ed, no curriculum to do it with.

When Tessa heard I’d be teaching sex ed to her fellow seventh graders, she was mortified. My husband suggested she wear a paper bag over her head, whereupon she rolled her eyes and walked away. When the day arrived, she slunk to the back of the room, sat down at a desk and lowered her head behind her backpack.

As I started in, 13 girls watched me with trepidation. I knew I needed to bring in the words they were dreading right away, so that we could move on to the important stuff. “Penis and vagina,” I said, and there were nervous giggles. A pencil dropped to the floor. With the pressure released, I moved on to talking about contraception, saying no, saying yes, pregnancy, sexually transmitted diseases, even roofies. By the end of the hour, hands were held urgently in the air, and my daughter’s head had emerged from behind her backpack.

Sexual education programming was promoted by the National Education Association as far back as 1892 as a necessary part of a national education curriculum. As information spread and birth control became increasingly available, unwanted pregnancies dropped, and rates of S.T.D.s plummeted. In this case, knowledge really is power.

I believe that this is true of death, too.

I am a doctor who practices both critical and palliative care medicine at a hospital in Oakland, Calif. I love to use my high-tech tools to save lives in the intensive-care unit. But I am also witness to the profound suffering those very same tools can inflict on patients who are approaching the end of life. Too many of our patients die in overmedicalized conditions, where treatments and technologies are used by default, even when they are unlikely to help. Many patients have I.C.U. stays in the days before death that often involve breathing machines, feeding tubes and liquid calories running through those tubes into the stomach. The use of arm restraints to prevent accidental dislodgment of the various tubes and catheters is common.

Many of the patients I have cared for at the end of their lives had no idea they were dying, despite raging illness and repeated hospital admissions. The reasons for this are complex and varied — among them poor physician training in breaking bad news and a collective hope that our technologies will somehow ultimately triumph against death. By the time patients are approaching the end, they are often too weak or disabled to express their preferences, if those preferences were ever considered at all. Patients aren’t getting what they say they want. For example, 80 percent of Americans would prefer to die at home, but only 20 percent achieve that wish.

Many of us would choose to die in a planned, comfortable way, surrounded by those we love. But you can’t plan for a good death if you don’t know you’re dying. We need to learn how to make a place for death in our lives and we also need to learn how to plan for it. In most cases, the suffering could have been avoided, or at least mitigated, by some education on death and our medical system. The fact is that when patients are prepared, they die better. When they have done the work of considering their own goals and values, and have documented those preferences, they make different choices. What people want when it comes to end-of-life care is almost never as much as what we give them.

I am a passionate advocate for educating teenagers to be responsible about their sexuality. And I believe it is past time for us to educate them also about death, an equally important stage of life, and one for which the consequences of poor preparedness are as bad, arguably worse. Ideally this education would come early, well before it’s likely to be needed.

I propose that we teach death ed in all of our high schools. I see this curriculum as a civic responsibility. I understand that might sound radical, but bear with me. Why should death be considered more taboo than sex? Both are a natural part of life. We may think death is too scary for kids to talk about, but I believe the consequences of a bad death are far scarier. A death ed program would aim to normalize this passage of life and encourage students to prepare for it, whenever it might come — for them, or for their families.

Every year in my I.C.U. I see dozens of young people at the bedsides of dying relatives. If we started to teach death ed in high school, a student visiting a dying grandparent might draw from the curriculum to ask a question that could shift the entire conversation. She might ask about a palliative care consultation, for example, or share important information about the patient’s preferences that she elicited during her course. High school, when students are getting their drivers’ licenses and considering organ donation, is the perfect time for this. Where else do we have the attention of our entire society?

Last week, my colleague Dawn Gross and I taught our first death ed program in my daughter’s ninth-grade class at the Head-Royce School, a private, progressive (and brave) school in Oakland. In the classroom, we had some uncomfortable terms to get out of the way early on, just as I did in sex ed — death, cancer, dementia. We showed the teenagers clips of unrealistic rescues on the TV show “Grey’s Anatomy,” and then we debunked them. We described the realities of life in the I.C.U. without mincing words — the effects of a life prolonged on machines, the arm restraints, the isolation. Everyone was with us, a little tentative, but rapt.

And then we presented the material another way. We taught them how to play “Go Wish,” a card game designed to ease families into these difficult conversations in an entertaining way. We asked students to identify their most important preferences and values, both in life and as death might approach. We discussed strategies for communicating these preferences to a health care team and to their own families.

We were delighted by their response. It didn’t take them long to jump in. They talked openly about their own preferences around death. One teenager told another that she wanted to make sure she wasn’t a burden to her family. A third said he was looking forward to playing “Go Wish” with his grandfather, who recently had a health scare.

Dawn and I walked out with huge smiles on our faces. No one had fainted. No one had run out of the class screaming. The health teacher told us she was amazed by their level of engagement. It is my hope that this is only the first step toward generating wide public literacy about this phase of life, which will eventually affect us all. The sooner we start talking about it, the better.

Aging Science

Aging Science is probably a misnomer. The field of Aging Science, if it can be called that, seems to be dismissed by the average scientist – and, sadly, many who plow fields here are thought to be quacks – people marketing magic potions and miracle cures.

Putting this cultural bias aside, a better truth seems to be that “aging” is actually a collection of highly specialized areas of biology, very specific age-related diseases, and a variety of issues related to healthy aging.

This post explores some of the issues, some of the people out there who are evangelizing the field, and some of the science that sustains them:

==================== Issue #1 – Biology of Aging =========

Stem Cells
DNA
Mitochondria
Caloric Restriction
Cellular Senescence
Genomes (Human Genome)
Longevity
Immune Response
Animal Models
Theories of Aging
Telomeres and Telomerase
Biomarkers of Aging
Oxidative Damage

==================== Issue #2 – Diseases of Aging =========

Alzheimers Disease
Stroke
Prostate Cancer
Osteoarthritis
Breast Cancer
Diabetes
Depression
Age-related Macular Degeneration
Osteoporosis

==================== Issue #3 – Healthy Aging =========

Healthy Aging
Smoking Cessation
Hearing
Alcohol Abuse
Oral Health
Immunization
Nutrition

Sadly, there is much cynicism out there when it comes to nutrition. One reason why: The Women’s Health Initiative (WHI) was a 15-year project involving 161,808 women aged 50 to 79. WHI caused many women (and men, for that matter) to question the value of maintaining a healthful diet.

Nonetheless, most physicians and nutritionists still emphasize the importance of keeping your daily fare rich in vegetables, fruit, and whole grains and spare in processed sugar and saturated fats.

==================== Issue #4 – Progress =========

Apparently, the average human age advances about 1-2 years per decade.

==================== People: Aubrey de Grey =========

Aubrey de Grey is a bearded Brit. He took a $15 million inheritance from his mother – 15 years ago – and decided to plow it into the anti-aging field. Many new outlets have given him an audience over these years, including 60 Minutes and TED. I personally am not clear on what he has to show for this 15 year investment of his time:

Aubrey de Grey theories about RHR and LEV:

Wikipedia about Aubrey de Grey

RHR is Robust Human Rejuvenation

LEV is Longevity Escape Velocity

TedTalk on YouTube here:

Aubrey de Grey YouTube

TedMed talk here:

TedMed 2009

Regenerative medicine and gerontology are the two fields

======= more ======
Pro-aging trance
The “pro-aging trance” is a term coined by Grey to describe “the impulsion to leap to embarrassingly unjustified conclusions in order to put the horror of aging out of one’s mind”.[34] According to de Grey, the pro-aging trance or “pro-aging edifice”[35] is a psychological strategy which people use to cope with aging, and which is rooted in the belief that aging is not only immutable and unavoidable, but desirable in some sense, as part of the natural or divine order that should not be perturbed. De Grey refers, in this regard, to the general public’s ambivalence towards aging. For example, he states that SENS research is often misunderstood or misrepresented as likely to lead to prolonging, rather than postponing, the period of decrepitude characteristic of old age — a belief that de Grey calls the “Tithonus error”, in reference to the myth of Tithonus. He describes this “pro-aging” stance as a rational response to the perceived inevitability of aging (compare related ideas and experimental findings in terror management theory[36]). However, de Grey believes that defeating aging is feasible and that the pro-aging trance represents a huge barrier to combating aging.[37]

Funding of SENS Research Foundation
In 2011, de Grey inherited roughly $16.5 million on the death of his mother.[38] Of this he assigned $13 million to fund SENS research, which by 2013 had the effect of roughly doubling the SENS Research Foundation’s yearly budget to $4 million. Other donors who have given millions to the Foundation include investor Peter Thiel.[38] The foundation also has yearly funding drives that have been successful with some significant donors offering matching grants for members of the public who donate.[39][40]

The seven types of aging damage
Main article: Strategies for Engineered Negligible Senescence
De Grey proposed the following types of aging damage:

Mutations – in Chromosomes causing cancer due to nuclear mutations/epimutations:
These are changes to the nuclear DNA (nDNA), the molecule that contains our genetic information, or to proteins which bind to the nDNA. Certain mutations can lead to cancer, and, according to de Grey, non-cancerous mutations and epimutations do not contribute to aging within a normal lifespan, so cancer is the only endpoint of these types of damage that must be addressed.
Mutations – in Mitochondria:
Mitochondria are components in our cells that are important for energy production. They contain their own genetic material, and mutations to their DNA can affect a cell’s ability to function properly. Indirectly, these mutations may accelerate many aspects of aging.
Junk – inside of cells, aka intracellular aggregates:
Our cells are constantly breaking down proteins and other molecules that are no longer useful or which can be harmful. Those molecules which can’t be digested simply accumulate as junk inside our cells. Atherosclerosis, macular degeneration and all kinds of neurodegenerative diseases (such as Alzheimer’s disease) are associated with this problem.
Junk – outside of cells, aka extracellular aggregates:
Harmful junk protein can also accumulate outside of our cells. The amyloid senile plaque seen in the brains of Alzheimer’s patients is one example.
Cells – too few, aka cellular loss:
Some of the cells in our bodies cannot be replaced, or can only be replaced very slowly – more slowly than they die. This decrease in cell number causes the heart to become weaker with age, and it also causes Parkinson’s disease and impairs the immune system.
Cells – too many, aka Cell senescence:
This is a phenomenon where the cells are no longer able to divide, but also do not die and let others divide. They may also do other things that they’re not supposed to, like secreting proteins that could be harmful. Cell senescence has been proposed as cause or consequence of type 2 diabetes.[41] Immune senescence is also caused by this.[citation needed]
Extracellular protein crosslinks:
Cells are held together by special linking proteins. When too many cross-links form between cells in a tissue, the tissue can lose its elasticity and cause problems including arteriosclerosis and presbyopia.[25][42]

References on Aging Science:

Other Resources

American Federation for Aging Research and their “InfoAging Series”
http://www.afar.org/infoaging/

Biology of Aging

http://www.afar.org/docs/migrated/110930_Infoaging_Guide_Stem_Cells_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_DNA_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_MITOCHONDRIA_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_CALORIC_RESTRICTION_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_CELLULAR_SCENESCENCE_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_LONGEVITY_Web.pdf
http://www.afar.org/infoaging/biology-of-aging/immune-response/
http://www.afar.org/docs/migrated/111114_ANIMAL_MODELSFR.pdf
http://www.afar.org/docs/migrated/111121_INFOAGING_GUIDE_THEORIES_OF_AGINGFR.pdf
http://www.afar.org/docs/migrated/111121_INFOAGING_GUIDE_TELOMERESFR.pdf
http://www.afar.org/docs/migrated/111213_BIOMARKERS_OF_AGING-web.pdf
http://www.afar.org/docs/120710_Human_Genome(FR).pdf
http://www.afar.org/docs/130114_Oxidative_Damage(FR).pdf

Healthy Aging

http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_SMOKING_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_HEARIN_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_ALCOHOL_ABUSE_WEB.PDF
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_ORAL_HEALTH_Web.pdf
http://www.afar.org/docs/migrated/110930_INFOAGING_GUIDE_IMMUNIZATION_Web.pdf
http://www.afar.org/docs/120712_Nutrition(FR).pdf

NIH’s National Institute for Aging: http://www.nia.nih.gov

Report on six types of disabilities and frequency among older Americans: NIH NIA on Disabilities

Report on Screening Tools and Technologies: NIH on Screening Tools and Technologies

List of all screening tests: Screening Tools List

Kuslansky G, Buschke H, Katz M, et al . Screening for Alzheimer’s disease: the Memory Impairment Screen versus the Conventional Three-Word Memory Test. J Am Geriatr Soc 2002;50:1086-91. – See more at: http://www.nia.nih.gov/research/cognitive-instrument/three-word-recall-three-word-memory-test#sthash.ewEmCsZ6.dpuf

Nir Barzilai, director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York
Brian K. Kennedy, CEO of the California-based Buck Institute for Research on Aging

Cochran Regimen for Anti-Aging