A Primer on Compression of Morbidity

If you spend much time reading around the topic of aging, human longevity, and medical progress, you'll soon run into the term "compression of morbidity." It is a hypothesis suggesting that advances in medical science are causing, or will cause, a compression of the terminal period of frailty, illness, and disability at the end of life, squeezing it into an ever-shorter fraction of the overall human life span. In colloquial use compression of morbidity is spoken of as a practical goal by medical researchers who do not wish to talk openly about extending human life for political or funding reasons. To my eyes the concept of compression of morbidity is rather too tied up with the self-defeating way in which gerontologists behaved with respect to human longevity for so many years: it makes it hard to discuss without pulling in the recent history of politics, funding organizations, and strategic debates within the aging research community. Some background from the archives can be found in the following posts:

Compression of morbidity as a concept also touches on debates and initiatives to persuade more of the research community to adopt repair-based research strategies such as SENS. These repair-based strategies for treating - and ultimately reversing - aging emerge fairly directly from the viewpoint that aging is little more than the effects of damage accumulation at the level of our cellular and molecular protein machinery. If you look at the body as a complex system that gathers damage, such as through the lens of reliability theory, compression of morbidity begins to seem a mirage of sorts. Any intervention that can slow or repair some of the biological damage that causes aging will extend life but not do much for the period of decline at the end - it just puts it off. This is the same for any machine. If you learn how to repair biological damage sufficiently comprehensively then you could put off that final decline indefinitely, which is the SENS goal. But if you stopped undergoing those periodic repairs, then you'd age just the same way and at the same pace as someone who never had the treatment.

But to return to the point of this post, which is to introduce the concept of compression of morbidity, I should mention that I stumbled across a good introductory open access paper today, written for a general audience by the originators of the compression of morbidity hypothesis. You might find it interesting:

Compression of Morbidity 1980-2011: A Focused Review of Paradigms and Progress

The Compression of Morbidity hypothesis - positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability - was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept.

Dive in and see what you think. The authors believe the data of the past decades illustrates that compression of morbidity is in fact occurring, and that improvement in the rate is possible given that no structured effort was expended towards this goal over that time. You might look at an older post here for a alternate explanation of the data with more of a damage-based view. No-one is arguing against the trend towards increasing life expectancy in the old and falling mortality rates for age-related diseases, but there is plenty of argument when it comes to the root causes of that trend - and therefore how to improve on it.

Comments

Living longer does not mean living well, with longevity comes higher risk for dibilitating disease. The health care system of the future is likely to suffer a huge increase in the demands of care when people are living longer. It is estimated that by the year 2030, one person will be diagnosed with dementia every seven seconds. I fear that Medicare/Medicaid systems will not be in effect by then and more awareness must be advertised upon for this epidemic to come. There is a need also in the awareness that many elderly individuals will choose to be in their own homes at that time with more traveling services coming to their doors. I surely see a crisis coming worldwide.

Posted by: Nancy Hower at June 5th, 2012 4:19 PM

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