Life In Dependence: Longevity for All

As the US celebrates July 4th, "Independence Day" let's take the time to acknowledge a portion of the population that may be a little more 'dependent.'

Longevity related topics (including many pieces in the Longevity Assistant newsletter) tend to be aimed at the 'average' person, assuming some basic level of physical and mental competence. At the ends the ability spectrum, mobility and mental acuity are challenges, but maximizing healthy years is still possible and very much desirable!

This matters for all of us, because:

1. Aging can significantly alter our abilities to do daily tasks.
2. The more "success" we have in longevity, the more potential we have to see a higher portion of the population with frailty issues.
3. The outlook for the caretaker industry is concerning. If you are not needing care, you will likely be required to provide care.

A Look at Lifespan and Healthspan

Lifespan

It is perhaps unsurprising to learn that people born with developmental disabilities (about 3.6 million adults in the US) have shorter lifespans. Naturally, this gap will vary based on severity of impairment, according to the Syracuse based Lerner Center for Public Health Promotion (2019).

The good news is that some cases, lifespans have had some large gains.

As an example, according to the Global Down Syndrome Foundation:

• In 1983, The life expectancy for someone with Down syndrome was 25 years.
• A more current estimate is around 60 years!
• As a comparison, in that same time period, US population life expectancy went from 75 to 79.

Ideally, we continue to shorten the gap between lifespans.

Healthspan and the QALY/DALY Debate

It seems intuitive to rate the value of a medicine or diet or action not just on whether it adds another year of life, but also if that year will be one you want to live through. That is, a remedy that leads to a loss of two functions is preferred over a remedy that leads to a loss of three functions. This is the essence of the "Quality Adjusted Life Years" or QALY and "Disability-Adjusted Life Years" or DALY metrics, used often in research, healthcare and insurance.

Yet, while this is an intuitive attempt to try to standardize measurements for different treatments (insulin vs chemotherapy for instance), there are some issues mathematically, and ethically.

For an example on the math, 4 years at 100% health would be rated the same as 10 years at 40% health. In one case you get to see your grandkids graduate high school. In the other you get to see them graduate college as well. Which would you prefer?

More importantly, there are several ethical consequences, which are well articulated in a 2019 collection of essays from the National Council of Disability.

• Does the measure imply that a disabled life has less value than an active one?
• When the base population is disabled (already has a low QALY score) would a treatment that offers some improvement be bypassed relative to a medicine that helps a different population?

Assessments could be complimented with several measures, and a decision matrix that evaluates many dimensions can help counter some of these shortfalls.

Moving beyond the math, let's now turn our attention to some considerations around practical ways to enhance the life of someone who may face challenges in the cornerstones of the Longevity Assistant Framework.

Longevity Assistant Adaptations

EAT

From Autism to Alzheimer’s, many conditions benefit from dietary interventions.??Many foods that are considered "healthy" are going to be healthy for anyone. Some challenges may be access to food, ability to cook and ability and willingness to eat.?

1. Research and partner with people who are familiar with cuisines that align with conditions.
2. Experiment with flavors and textures and environment for eating.
3. Consider abandoning cutlery and make more finger foods.

MOVE

Again, as a general rule, activity can promote wellness.?Sometimes movement means walking to the kitchen and back. However, many YouTube yoga videos won't feature someone in a wheelchair. Adapting fitness and movement to a person's abilities is totally possible and can be a lot of fun.

The "Just Dance" video game brings fun and movement together in an inclusive manner in several of their videos that offer "seated dances." This brings dance moves to people with spinal damage, weight issues, or even your great grandmother!

Aquatics are often a great option. Getting in to the pool can be a pleasant experience for folks with sensory issues, and is also easier on the joints, allowing or wider ranges of movement.

Having a 5K coming up? Races are awesome because a lot of times they take place outside where you can have exposure to sunlight and trees. Just make it a walk/run/roll event to add inclusivity, and for even more fun, compete as a team!

• TECHNOLOGY will also be something that may become a game change. Adam Gorlitsky, a man who competes in Marathons wearing an exoskeleton, created I GOT LEGS to support advances in exoskeletons

Finally, a huge shout out to Special Olympics, who celebrated their 50th anniversary in 2018. ?

The mission of Special Olympics is to provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community.

For more resources on corporate wellness inclusivity, reference this guide from the National Center on Health, Physical Activity and Disability (NCHPAD).

REST

Some people will struggle to meditate. For the chronically ill or people with trauma and certain mental afflictions, it can be hard to be quiet.??Support through music and art offer nice alternatives.

Therapy animals from dogs to dolphins are also great assets for restoring a sense of calm. There are also many anecdotal stories of dogs being able to "detect" seizures or blood sugar abnormalities.

CONNECT

Having an illness or different way of being in the world can sometimes create barriers for inclusivity. Thankfully, a lot of progress has been made since the passing of the Americans with Disabilities Act. More can still be done.

For example, webpages are adding accessibility options more and more. With advance of AI tools, building inclusive options like an audio version of a website, evaluating color scheme and font size can be done more readily.

Online forums, like THE MIGHTY can be an oasis of support in the fights against difficult conditions.

Volunteering with group homes, senior centers and other care facilities helps residents, staff, and volunteers.

People with mental or physical impediments are people first and we can all make a human connection.