By 2050, there will be almost 120 million people aged 80 years or older living in China alone, 434 million are expected to reach this age worldwide by the middle of the century.
Recognizing the growing demand for treatments, research into geriatric health conditions has surged in recent years.
Biotechnologies are revolutionizing our management of aging populations by offering regenerative and genetic interventions that heal illnesses by restoring malfunctioning cells, tissues and organs.
Digital technologies and smart devices are already monitoring the health status of people of all ages, the world over.
Today, for the first time in history, most people in the world can expect to live into their sixties and beyond. Globally, 125 million people are aged 80 years or older. By 2050, there will be almost this many (120 million) living in China alone, and 434 million people aged 80 years or older are expected to live worldwide by the middle of the century. China’s latest five-year plan, for which the ‘Two Sessions’ meeting was held on 4th March 2021, acknowledged the problem, building on the previous year’s announcement that the number of citizens aged 60 or over accounted for 18.1% of the Chinese population in 2020. As that number is expected to grow, policies aimed at boosting fertility and rebalancing the population are being initiated.
“More inclusive population policies will be introduced to improve fertility, the quality of the workforce and the structure of the population,” said Yuan Xin, Vice President of the China Population Association.
Maintaining Health and Independence
All being well, children born today should live well into their 80s, giving them precious extra years to pursue new activities, spend time with their families, and hopefully contribute to the societies in which they live. The extent of those opportunities and contributions depends heavily on them maintaining their health and independence but, according to the World Health Organization (WHO), at the moment there is little evidence to suggest that older people are experiencing better health in their later years, compared with previous generations. In other words, we may be keeping people alive for longer, but at the moment we’re not necessarily giving them a life that is as enjoyable as we might hope.
This has driven healthcare systems across the globe to develop policies aimed toward healthier aging. As the adage goes, prevention really is better than cure. Common conditions in older age include:
Hearing and sight problems
Back and neck pain
Osteoarthritis
Chronic obstructive pulmonary disease
Diabetes
And a range of geriatric syndromes such as frailty, urinary incontinence, and a heightened risk of fall.
Preventing or delaying these chronic debilitating conditions would go a long way towards keeping us healthy, and could also save health authorities considerable costs in terms of medications and care.
Breakthroughs in Geriatric Health
Recognising the growing demand for treatments, research into many of these conditions has surged in recent years. For example,
Osteoporosis
Pfizer and Eli Lilly’s tanezumab, a new monoclonal antibody against nerve growth factor, is currently under review by the FDA as a treatment for pain in osteoporosis patients. Possibly even more exciting, however, in the first two months of 2021, were the recent FDA approvals for Signature Biologics to proceed with a study of human umbilical cord tissue allografts in osteoarthritis patients, and for Histogen to proceed with a clinical trial of human extracellular matrix to regenerate hyaline cartilage. If successful, products such as these would be the first to repair the tissue damage caused to osteoarthritis, rather than simply managing the pain.
Diabetes
Similarly, researchers have made great advances in diabetes care in recent years. In 2019, a new artificial pancreas system was approved by the FDA, along with an immunotherapy treatment called teplizumabab that delays type 1 diabetes.
In the same year, it was discovered that a number of medications that had been approved in recent years, including SGLT2 inhibitors and GLP1s, not only helped to lower blood sugar levels, but also helped to protect the heart and kidneys. As such, 2019 was celebrated as a great year for diabetes research!
However, researchers are still looking for a cure, and perhaps that day is not so far away. For example, in March 2020, while most of the world was focussed on COVID, researchers at the Washington University School of Medicine in the US published their findings that human stem cells can be converted into insulin-producing cells to control blood sugar levels and, in effect, can ‘cure’ type 1 diabetes [1]. Meanwhile, various researchers have been developing a diabetes vaccine that stops the immune system from attacking its own body’s insulin-producing beta cells. Other groups have been evaluating the potential for islet cell encapsulation, which uses stem cells to create insulin-producing cells that can work without immune system interference.
“Cures for both type 1 diabetes and type 2 diabetes have not yet been discovered, but progress is being made to prospectively cure type 1 diabetes in this generation”, declares the British charity Diabetes UK. “Researchers are beginning to get excited again that a cure or near-cure treatment could come as early as within the next decade or two.”
Alzheimer’s
Of course, it’s not only the body that can fail. One of the saddest consequences of old age is seen in the 54 million people currently living with dementia around the globe. The UK Alzheimer’s Society estimates that this number will rise to 130 million by 2050. Once accepted as an inevitable part of aging, the past 25 years has seen a dramatic change in attitudes, largely thanks to the cholinesterase inhibitors that offered the first effective treatments for dementia in the 1990s. However, these drugs never provided a cure – they simply relieved the symptoms and, at best, might have slowed the progression of the disease, potentially giving patients another year or two of ‘being themselves’.
In searching for a curative treatment, numerous groups have worked on products targeting the microscopic clumps of amyloid plaques that characterize Alzheimer's disease, or the tau protein strands that are seen to ‘tangle’ in the Alzheimer brain. Other researchers have looked at modulating inflammatory processes, the effects of insulin on brain cell function, hormones, high blood pressure, heart disease, stroke, diabetes and high cholesterol... the quest for a cure for dementia continues.
Most recently, in the March 2021 issue of the New England Journal of Medicine, Phase II results of Eli Lilly’s donanemab (N=257), an antibody that targets beta-amyloid, suggested that the drug was associated with better cognitive scores, compared with placebo, and appeared to slow the accumulation of tau across key brain regions in Alzheimer’s patients [2]. Lilly has since announced that it will enrol another 1,000 participants into an expanded trial – TRAILBLAZER-ALZ 2 – to confirm the efficacy and safety of donanemab in a larger population. Results are expected in 2023, raising hopes that a cure for dementia might finally be imminent.
The Shift in Focus
These examples represent a shift in focus away from conventional symptomatic treatments of chronic conditions. What many of the ‘new breakthroughs’ have in common is a focus on prevention and – where possible – cure.
The fact that these treatments are emerging now is largely thanks to new technologies that were not available to previous generations of researchers. Biotechnologies are revolutionizing our management of our aging populations by offering regenerative and genetic interventions that heal illnesses by restoring malfunctioning cells, tissues and organs. Ultimately, biotechnologies may offer the holy grails of disease prevention and cure. Techniques to prevent or replace lost body functions can be seen to ‘borrow from’ the body’s own natural development processes – for example, the use of stem cells for organ regeneration, or the use of hormone therapies for lost bone, cartilage and muscle mass. Biotechnology holds the promise of alleviating the disabling conditions that plague our later years.
An aging global population offers numerous opportunities for the biological pharma industry, both in terms of providing preventative treatments that maintain health and independence into old age, and for new service offerings that make use of the ongoing digital revolution. It is interesting to see how many pharma companies are embracing this approach, with many adapting their business models accordingly. As well as traditional drug development, an increasing number of pharma companies are also looking for growth opportunities in pioneering technologies for data collection, analysis and interpretation. This is another opportunity to make use of the Big Data that now seems to reach into every part of our lives.
We are already seeing automated campaigns, based on medications or disease states, that educate patients, offer helpful reminders, or check on progress at key times. Ultimately, it is hoped that drugs will eventually be customized based on patients’ examination reports and medical records, providing effective, individualized preventative treatments that will help us all stay healthier and independent for longer.
The top ten medical technologies for 2021 have been identified by MedicalTechnologySchools.com as being:
Digital technologies and smart devices are already monitoring the health status of people of all ages, the world over. If those technologies were applied to detect signs predictive of conditions typically associated with old age, symptoms could be detected at an early stage and treated as effectively as possible, as soon as possible, potentially preventing or delaying those chronic debilitating illnesses that can make old age so difficult.
By 2050, those of us who have joined the ranks of our cherished older generations will perhaps see for ourselves the fruits of these labours. Hopefully, if we are fortunate enough to live long lives, we will have the chance to live them in a fulfilling and healthy manner.
References:
1.Hogrebe, N.J., Augsornworawat, P., Maxwell, K.G. et al. Targeting the cytoskeleton to direct pancreatic differentiation of human pluripotent stem cells. Nat Biotechnol 38, 460–470 (2020). https://doi.org/10.1038/s41587-020-0430-6
2.Mintun, M.A., Lo, A.C., Evans, C.D., et al. Donanemab in Early Alzheimer’s Disease. NEJM published on-line early march 13th, 2021. https://www.nejm.org/doi/full/10.1056/NEJMoa2100708
Author biography
Sarah Harding, PhD
Editorial Director of Chemicals Knowledge
Sarah Harding worked as a medical writer and consultant in the pharmaceutical industry for 15 years, for the last 10 years of which she owned and ran her own medical communications agency that provided a range of services to blue-chip Pharma companies. She subsequently began a new career in publishing as Editor of Speciality Chemicals Magazine, and then Editorial Director at Chemicals Knowledge. She now focusses on providing independent writing and consultancy services to the pharmaceutical and speciality chemicals industry.
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