AGING AND GERIATRIC CARE: A GLOBAL IMPERATIVE TOWARDS UNIVERSAL

HEALTH COVERAGE

Authors: Shristi Singh1 https://orcid.org/0009-0001-3375-2036

Rajkishor Yadav1 https://orcid.org/0009-0009-0904-0686

Bohdana Doskaliuk 2 https://orcid.org/0000-0003-1650-8928

Affiliations:
1
Undergraduate student, Ivano-Frankivsk National Medical University
2
Department of patophysiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk,
Ukraine
Corresponding author:
Bohdana Doskaliuk, MD. Department of patophysiology, Ivano-Frankivsk National Medical
University, Ivano-Frankivsk, Ukraine
Twitter handle: @DDoskaliuk
Email: Doskaliuk_Bo@ifnmu.edu.ua

Abstract:
The global population of older people is projected to surpass the number of children under 5 years
old and adolescents by 2050, with developing countries housing the majority of older individuals.
This demographic shift necessitates adjustments in global health systems to cater to the increasing
demand for age-appropriate care. Gerontology, as an interdisciplinary field, encompasses the study
of biological, social, and medical aspects of aging. Anti-aging, a distinct discipline, focuses on
understanding and combatting age-related ailments. This review provides insights into the
distinctive aspects of anti-aging research, highlights current priority issues in health promotion and
anti-aging measures, and explores implications of crises on aging research and healthcare.
Furthermore, it emphasizes the need for collaboration among interdisciplinary research networks,
integration of science and technology, and the involvement of key stakeholders to ensure universal
health coverage. Future research should address the multidimensional aspects of healthy aging,
reflect research priorities and preferences of older individuals, and promote health equity. This
collective effort will contribute to the development of innovative solutions and facilitate cross-
learning among countries to enhance the well-being of aging populations globally.
Keywords: aging; health; anti-aging research; science.

Intrduction

The global population of older people is expected to reach 2.1 billion by 2050, surpassing
the number of children under 5 years old [1]. By 2050, the older population will also outnumber
adolescents and young people aged 15-24 years. Developing countries are home to the majority of
older people, with 37% residing in eastern and south-eastern Asia, 26% in Europe and North
America, 18% in Central and South Asia, 8% in Latin America and the Caribbean. The number of
people aged 60 years and older is projected to grow rapidly in developing countries, from 652
million in 2017 to 1.7 billion in 2050, while more developed countries will experience an increase
from 310 million to 427 million [1]. Africa, Latin America, the Caribbean, and Asia are witnessing
the fastest growth in their older populations.

It is estimated that by 2050, nearly 80% of the world's older population will reside in less
developed countries. The proportion of older people in the overall population is expected to increase
in most countries, from one in eight in 2017 to one in six by 2030 and one in five by 2050 [2].

The speed at which the population is aging is increasing, which means that global health
need to adjust quickly to address the requirements of their aging populations. The field of studying
the physiological and pathological aspects of aging has seamlessly integrated itself into the realm of
medicine, becoming an indispensable component. Presently, there exist diverse branches within this
domain, each dedicated to scrutinizing distinct parameters and characteristics of the aging process.

Gerontology, an interdisciplinary field encompassing biology and medicine, endeavors to

unravel the intricate patterns of aging in all living organisms, including the complexities exhibited
by the human species. It encompasses several subdivisions, namely the biology of aging, social
gerontology, and geriatrics [3]. The biology of aging delves into the mechanisms underlying the
aging process across various hierarchical levels, ranging from the molecular to the organismal scale.
Social gerontology examines the multifaceted aspects of aging through a lens that incorporates
demographic, socio-economic, socio-hygienic, and socio-psychological factors [4]. It investigates
the impact of environmental conditions and lifestyle choices on the aging trajectory of individuals
while devising strategies to ensure the well-being and active longevity of the elderly population.
Biogerontology, on the other hand, focuses its attention on exploring the biological dimensions of
aging [5].

Anti-aging, often recognized as a distinct scientific discipline from gerontology,

concentrates on comprehending the ailments that afflict the elderly and formulating effective
approaches to combat them. The fundamental tenets of anti-aging revolve around age, aging, old
age, longevity, and immortality, encapsulating human conceptions of life processes, the immutable
laws governing existence, and mankind's innate yearning for life extension [6]. It is crucial to draw
a clear distinction between the concepts of aging and old age. Consequently, the core principles of
anti-aging medicine are rooted in the application of cutting-edge scientific and medical technologies
that facilitate early detection, prevention, treatment, and mitigation of age-related diseases [7]. The
main goal in hindering the aging process is not just to extend lifespan, but to improve the overall
quality of life in old age. Notably, renowned Ukrainian scientists such as I. I. Mechnikov and O. O.
Bogomolets have made significant contributions to this field [8, 9].

In this review, our aim was to provide insights into the distinctive aspects of anti-aging
research, including its primary areas of focus, challenges, and potential future prospects.

Current priority issues in health promotion and anti-aging measures

The phenomenon of population aging is a result of advancements in human development,

such as better health, increased lifespan, and reduced mortality rates. However, it also presents a
significant challenge for public health systems to adjust and cater to the increasing need for age-
appropriate care, including long-term care, preventive services, and technologies for disease
detection and treatment. Population aging, combined with changes in lifestyle and the
epidemiological transition, is a major contributing factor to the growing occurrence and prevalence
of non-communicable diseases [10].

While many countries acknowledge older persons as a vulnerable group at risk of being
marginalized, some countries take specific measures to prevent their exclusion. For instance,
Australia emphasizes collaborative efforts between the government, private sector, and civil society
to tackle workforce participation gaps. Australia also highlights investigations conducted by the
Australian Human Rights Commission into employment barriers faced by older individuals [11].

The 'National Health Programme' of Poland for the period 2016-2020 includes the
prioritization of healthy and engaged aging as one of its main focuses [12]. Poland also advocates
for the Active Ageing Index, which intends to assess the capacity of older individuals to contribute
more to the economy, society, and independent living [13]. The active ageing index was created by
combining measures from four key areas: employment, societal participation, independent living
with regards to health and safety, and the potential and circumstances for active aging. In Poland,
the Medicines 75+ program aims to, among other things, ensure that older individuals have access
to free medications and medical devices necessary for treating age-related illnesses [14].

The Netherlands emphasizes its research priorities at specialized institutes like the
Amsterdam Institute for Global Health and Development and the Rotterdam Global Health
Initiative. These institutes, among others, specifically concentrate on areas such as aging and
Alzheimer's disease as well as dementia [15].

Science growth before 2022, available research infrastructure, international collaboration,

available indexed journals for covering aging and geriatric care issues.
 The available research infrastructure for aging and geriatric care varies across different
countries and institutions [16]. Countries with well-developed healthcare systems and a focus on
aging populations tend to have better research infrastructure in this field. These include countries
such as the United States, United Kingdom, Germany, and Switzerland [17-21]. These countries
have research institutes, universities, and medical centers that conduct studies and provide resources
for aging and geriatric care research. Additionally, there are specialized research centers and
institutes dedicated to aging and gerontology, such as the National Institute on Aging (NIA) in the
United States.

International collaboration plays a significant role in advancing research in aging and

geriatric care. Collaboration between researchers and institutions from different countries allows for
the exchange of knowledge, expertise, and resources, leading to a broader and more comprehensive
understanding of aging-related issues (Fig. 1). International collaborations also help in addressing
global challenges related to aging and developing innovative solutions.

Figure 1. The visualizing authors network. (The minimum threshold for authors occurrence was set at 5).

Furthermore, it is crucial to acknowledge the significance of interdisciplinary collaboration,

as it can enhance the significance of studies and provide fresh perspectives within the field of anti-
aging. It is important to recognize that the study of age-related topics extends beyond the realm of
medicine alone, and various disciplines can contribute valuable insights in this area (Fig. 2).
 Figure 2. Distribution of aging related scientific papers within different disciplines

The field of aging and geriatric care is covered in indexed journals that provide valuable
insights and research findings.These journals provide a platform for researchers to publish their
findings, share insights, and contribute to the field. Currently there are 113 indexed journals, many
from them are relatively young and has been indexed in 21 st century only. We focused on the top 10
journals in this field based on the Scimago Journal Ranking data (Fig 3).

At the top of the list is Nature Aging, a journal based in Germany, with an impressive SJR
score of 4.336. This journal emphasizes the interdisciplinary nature of aging research, covering
areas such as biochemistry, genetics and molecular biology, medicine, and neuroscience. With a
total of 136 published documents in 2022, the Nature Aging has garnered a high number of citations
per document over a two-year period, indicating the significance and impact of its publications.
Notably, it was only indexed by Scopus in 2021, yet by 2022, it had already achieved the status of a
Q1 journal. Additionally, it is interesting to observe that half of the top 10 journals on the list were
indexed by Scopus after the year 2000, indicating the emerging nature of this scientific field.

These top 10 journals demonstrate the widespread research and scholarly contributions in
the field of aging and geriatric care. These journals play a crucial role in disseminating valuable
knowledge, promoting interdisciplinary collaboration, and addressing the diverse challenges
associated with aging populations worldwide.
 Figure 3. The overview of the top journals in the field of geriatrics and gerontology based on their
SJR (SCImago Journal Rank) scores

Implications of the crisis on research and healthcare

The implications of a crisis, such as a pandemic or any other significant event, on research
and healthcare in aging is significant. During a crisis, research activities may be disrupted due to
restrictions on travel, limited access to research facilities, and diversion of resources to address the
crisis [22]. This can impact ongoing studies, delay data collection, and hinder the progress of
research projects focused on aging and related areas.

During a crisis, research priorities shifted to address immediate healthcare needs and public
health concerns [23]. Funding and resources are redirected towards crisis management, leaving less
support for research specifically focused on aging. This shift in priorities can temporarily impact the
advancement of aging-related research.

The former COVID-19 crisis has had a significant impact on clinical trials focused on
interventions or treatments for age-related conditions [24]. Delays in these trials occured as various
factors were affected. The recruitment of participants, monitoring of trial participants, and
regulatory processes experienced disruptions, resulting in longer timelines for trial completion and
potential setbacks in therapy development [25].

The pandemic has placed significant strain on healthcare systems and resources, impacting
the provision of healthcare services for older adults [26]. As a consequence, access to routine
medical care has been reduced, screenings have been delayed, and specialized geriatric services
have become less available. Older adults were facing difficulties in receiving timely and suitable
care for their age-related conditions [27].

Nevertheless, crises can also stimulate innovation and adaptation in the fields of research
and healthcare. Researchers and healthcare providers may discover novel approaches to delivering
care remotely, utilizing telemedicine and digital health solutions, and harnessing the power of data
analytics to support aging populations during crises [28-30]. The sense of urgency generated by
such situations often fosters creative solutions and encourages collaborative efforts.

Main directions for future research

Research focused on healthy aging should address the current and future needs of older
individuals while considering the multidimensional aspects of healthy aging, including social,
biological, economic, and environmental factors [31]. It is essential to examine the determinants of
healthy aging throughout different stages of life, from early adulthood to late life, and evaluate
interventions aimed at enhancing healthy aging trajectories. Furthermore, studies should align with
research priorities, address gaps in existing evidence, and take into account the preferences and
perspectives of older individuals [32]. Gender sensitivity and the pursuit of health equity should
also be key considerations in study design. The synthesis of evidence regarding activities and
interventions that benefit older people, their families, and communities, along with strategies for
scaling up these interventions to reach a larger population, should be actively encouraged.
Ultimately, innovations in healthy aging research should be relevant and have a tangible impact on
people's lives. Building a comprehensive knowledge base on healthy aging is a collective effort that
involves contributions from every country and offers opportunities for cross-learning [33].

Conclusion

Global health system can make significant progress towards achieving universal health
coverage by providing person-centered, integrated care and comprehensive primary health services
that cater to the needs of older individuals. This necessitates collaboration among interdisciplinary
research networks comprising practitioners, professionals, policy-makers, older people, and
researchers. To address the challenges faced in policy and practice, it is crucial to integrate science,
technology, social innovation, and business innovation to generate innovative ideas. Key
stakeholders involved in this process will include multinational corporations, regional and global
intergovernmental organizations, as well as academic research, development, and innovation
institutions. By bringing together these diverse stakeholders and leveraging their expertise,
countries can advance their efforts towards ensuring that a larger proportion of the population
benefits from universal health coverage.
Author Contributions Statement: Author Contributions Statement: BD design and
conceptualisation. BD, SS, RY writing of the initial manuscript; BD, SS, RY draft review. BD
construction of figures. All authors approved the final manuscript as submitted and agree to be
accountable for all aspects of the work.

Compliance with ethical standards: No human participants/animals were evaluated. These data
are public. Therefore, there was no requirement for ethics committee approval.
Conflict of interest: The authors declare no conflicts of interest.
Funding: No funding was received for this study.

References

1. World population ageing 2019. Highlights. New York City (NY): United Nations,
Department of Economic and Social Affairs; 2019 (ST/ESA/SER.A/430)
(https://www.un.org/en/development/desa/population/publications/pdf/ageing/
WorldPopulationAgeing219-Highlights.pdf , accessed June 2023).

2. World Health Organization, Ageing and health

https://www.who.int/news-room/fact-sheets/detail/ageing-and-health , accessed June 2023.

3. Twigg J, Martin W. The challenge of cultural gerontology. Gerontologist. 2015

Jun;55(3):353-9.

4. Marty Martinson, Clara Berridge, Successful Aging and Its Discontents: A Systematic
Review of the Social Gerontology Literature, The Gerontologist, Volume 55, Issue 1, February
2015, Pages 58–69

5. Rattan SIS. Biogerontology: research status, challenges and opportunities. Acta Biomed.
2018 Jun 7;89(2):291-301.

6. Picca A, Marzetti E. Advancements in Anti-Aging Treatment Development. Int J Mol Sci.

2023 May 10;24(10):8515

7. Xu Y, Kim JS, Li M. Illuminating anti-ageing. Nat Chem. 2023 Apr;15(4):451-452

8. Doskaliuk, B. (2022). Oleksandr Bogomolets is a visionary of anti-aging in Ukraine. Anti-

Aging Eastern Europe 1(1): 43-46.

9. Doskaliuk, B. (2023). Élie Metchnikoff’s legacy in the field of orthobiosis. Anti-Aging

Eastern Europe 2(1): 54-58

10. Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. Eur
Respir J. 2014 Oct;44(4):1055-68
11. Australian Human Rights Commission. 9 Barriers to employment
https://humanrights.gov.au/our-work/9-barriers-employment-0 accessed June 2023.

12. Romanowska A, Morawiak A, Woods C, Kelly L, Volf K, Gelius P, Messing S, Forberger S,

Lakerveld J, Den Braver NR, García Bengoechea E, Żukowska J; PEN Consortium. Health
Enhancing Physical Activity Policies in Poland: Findings from the HEPA PAT Survey. Int J Environ
Res Public Health. 2022 Jun 14;19(12):7284.

13. Perek-Białas J, Varlamova M. Policy Implications of the Active Aging Framework in

Poland. Innov Aging. 2021 Dec 17;5(Suppl 1):428.

14. National report – POLAND. Information on the actions taken for the benefit of elderly
people as part of the fourth review and appraisal cycle of the implementation of the Madrid
International Plan of Action on Ageing and its Regional Implementation Strategy (MIPAA/RIS)
2017 – 2021. https://unece.org/sites/default/files/2021-10/mipaa20-report-poland.pdf accessed June
2023

15. Huijsman R. Understanding and Balancing Generalist-Specialist Approaches in Dementia

Research and Care Practice, Qualitative Research with 44 Dementia Professors in The Netherlands.
Int J Environ Res Public Health. 2023 Feb 21;20(5):3835

16. Fotso J, Kuate-Defo B. Measuring socioeconomic status in health research in developing

countries: should we be focusing on households, communities or both? Soc Indicators Res. (2005)
72:189–237.

17. Giguere AMC, Farmanova E, Holroyd-Leduc JM, Straus SE, Urquhart R, Carnovale V,
Breton E, Guo S, Maharaj N, Durand PJ, Légaré F, Turgeon AF, Aubin M. Key stakeholders' views
on the quality of care and services available to frail seniors in Canada. BMC Geriatr. 2018 Nov
26;18(1):290.

18. Heller T, Sorensen A. Promoting healthy aging in adults with developmental disabilities.
Dev Disab Res Rev. (2013) 18:22–30. doi: 10.1002/ddrr.1125

19. McMaughan DJ, Oloruntoba O, Smith ML. Socioeconomic Status and Access to Healthcare:
Interrelated Drivers for Healthy Aging. Front Public Health. 2020 Jun 18;8:231

20. Roth L, Seematter-Bagnoud L, Le Pogam MA, Dupraz J, Blanco JM, Henchoz Y,

Peytremann-Bridevaux I. Identifying common patterns of health services use: a longitudinal study
of older Swiss adults' care trajectories. BMC Health Serv Res. 2022 Dec 26;22(1):1586

21. Hajek A, Bock JO, König HH. Which factors affect health care use among older Germans?
Results of the German ageing survey. BMC Health Serv Res. 2017 Jan 13;17(1):30
22. Santos LC, Low YH, Inozemtsev K, Nagrebetsky A. Clinical Research Redirection and
Optimization During a Pandemic. Anesthesiol Clin. 2021 Jun;39(2):379-388.

23. Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global

Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic
Measures and Problems. J Pers Med. 2022 Aug 7;12(8):1295

24. Rhodus EK, Bardach SH, Abner EL, Gibson A, Jicha GA. COVID-19 and geriatric clinical
trials research. Aging Clin Exp Res. 2020 Oct;32(10):2169-2172. doi: 10.1007/s40520-020-01705-x

25. Chen Z, Chen L, Chen H. The impact of COVID-19 on the clinical trial. PLoS One. 2021
May 11;16(5):e0251410.

26. Myers LC, Liu VX. The COVID-19 Pandemic Strikes Again and Again and Again. JAMA
Netw Open. 2022;5(3):e221760

27. Vigezzi GP, Bertuccio P, Amerio A, Bosetti C, Gori D, Cavalieri d'Oro L, Iacoviello L,
Stuckler D, Zucchi A, Gallus S, Odone A, Lost In Lombardia Project Investigators. Older Adults'
Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles
(LOST) in Lombardia Project. Int J Environ Res Public Health. 2022 Sep 7;19(18):11271

28. Auais, M., Cameron, J., Turnnidge, J., Dalgarno, N., Kolomitro, K., Pelland, L. (2023).
GeroCast: Using podcasting to deliver living cases in gerontology education. Health Education
Journal, 82(2), 129–142.

29. Schulz R, Wahl HW, Matthews JT, De Vito Dabbs A, Beach SR, Czaja SJ. Advancing the
Aging and Technology Agenda in Gerontology. Gerontologist. 2015 Oct;55(5):724-34.

30. Rowe JW, Kahn RL. Successful Aging 2.0: Conceptual Expansions for the 21st Century. J
Gerontol B Psychol Sci Soc Sci. 2015 Jul;70(4):593-6.

31. Barbaccia V, Bravi L, Murmura F, Savelli E, Viganò E. Mature and Older Adults' Perception
of Active Ageing and the Need for Supporting Services: Insights from a Qualitative Study. Int J
Environ Res Public Health. 2022 Jun 23;19(13):7660.

32. Marshall A, Rawlings K, Zaluski S, Gonzalez P, Harvey G. What do older people want from
integrated care? Experiences from a South Australian co-design case study. Australas J Ageing.
2021 Dec;40(4):406-412.

33. Woods, T., Palmarini, N., Corner, L., Barzilai, N., Bethell, L. J., Cox, L. S., Siow, R. C.
(2022). Quantum Healthy Longevity for healthy people, planet, and growth. The Lancet Healthy
Longevity, 3(12), e811-e813.