UAlbany epidemiologist Allison Appleton, director of the Center for Healthy Aging, breaks down what healthy aging actually looks like, why understanding it matters now more than ever and how artificial intelligence could reshape care and quality of life for older adults. She also explains her research on the epigenetic clock as a biological measure of aging and shares practical advice for aging well.
Part of our conversation covered practical ways that AI-enabled technologies could support healthy aging in a variety of contexts — from preventing falls and providing companionship to facilitating difficult conversations surrounding end-of-life decisions.
Host: For anyone who's hearing this who might be skeptical about AI and might feel uncomfortable about the idea of it being involved in some of these really sensitive areas, what would you say to them?
AA: That’s an important point. I would say two things. One is that AI is a tool, just like any other tool or intervention approach that we've ever developed to make health better. Like other new tools, we need to figure out how to wield it wisely, taking advantage of its benefits while being cautious in our approach.
With this, there’s the question of how can we trust AI? How do we know it’s being developed and deployed responsibly?
In many realms, whether it's public health or social sciences or in the public domain, we are worried and wondering about the safe and secure ways in which our information is being handled. At the same time, conversations around AI safeguards and ensuring that these tools are being developed with user safety and privacy in mind, are growing. There’s real momentum there and I think in the coming months or years we’ll start to see more of that becoming codified.
We certainly need to be mindful about the ways in which our information is being used, particularly when we're talking about sensitive health information or really emotional concepts. This isn’t to say there aren't protections in place, there are, but there should be more visibility around the ways in which AI is already protecting that important information.
As much as new technology can feel intimidating or concerning, AI tools are also being developed specifically to protect older adults from nefarious technologies, like internet-based scams. There are AI tools being developed to protect the outflow of information on health, financials, social security information.
So maybe we need to shine a light on that and help people understand that like so many things, this is a two-sided coin. While we're worried about AI potentially mishandling our data, AI also has the potential to offer powerful protections.
Healthy aging has a long history at UAlbany.
For 26 years, the Internships in Aging Project has been a signature experiential learning program in the School of Social Welfare, giving students hands-on experience in a variety of professional environments supporting older adults. Students in the program earn academic credit and a stipend.
This spring, the program received a $2 million grant from the Hearst Foundations, enabling it to accommodate more students than ever, including those in the Master of Public Health program at the College of Integrated Health Sciences.
Interested in learning more about how researchers are trying to put a finer point on how we measure age? In a vein similar to Allison’s work on the epigenetic clock, The New York Times recently reported on another metric: intrinsic capacity.
Audio editing and production by Scott Freedman
Photo by Patrick Dodson
Interview by Erin Frick
Hosted and written by Erin Frick
Host (00:03):
Welcome to The Short Version, the UAlbany podcast that tackles big ideas, big questions, and big news in less time than it takes to cross the academic podium. I'm Erin Frick in UAlbany's Office of Communications and Marketing.
Allison Appleton (00:16):
Healthy aging doesn't just mean that we're trying to avoid disease or avoid disability, that people can live with chronic conditions and still age really well, maintaining function, autonomy, meaningful relationships, quality of life. We're not talking about the absence of disease and disability as we age, we're talking about enhancing quality of life during the years that we have.
Host (00:38):
The quest for immortality is as enduring as its aim. Sure, we've stopped searching for a literal fountain of youth, but the pursuit lives on in the wellness aisle, where a steady stream of supplements and devices promises to turn back the clock. But as we fixate on ways to live longer, we might be missing important ways to make those years count. Enter healthy aging. While longevity tallies the number of years we live, healthy aging asks how good those years really are. And it's not just about receiving a glowing report at your annual physical. Healthy aging is the culmination of a lifetime of behaviors and exposures that shape us along the way. This is the focus of UAlbany epidemiologist, Allison Appleton, who directs the Center for Healthy Aging. The center brings together UAlbany researchers working on healthy aging across disciplines and connects them with community partners to support older adults' health, fulfillment and wellbeing.
Allison's work examines how experiences from our earliest years influence the way we grow old. For example, how hardship in childhood can drive chronic stress and raise heart disease risk decades later. While these early experiences are important to understand, according to Allison, our physiology is malleable and the choices we make well into later life still matter. Allison also studies how targeted interventions throughout life can help a person live better in older age. By 2050, the global population of people over 80 is expected to triple. Ensuring that our aging population is equipped to live safely and comfortably is critical, and their caregivers and clinicians need strong support too.
In this week's episode, Allison explains what healthy aging really means, why we urgently need to understand it now, and how AI could help improve quality of life and care as we grow older. She also explores an important measure of age that won't appear on a birthday cake, plus her best advice for aging well.
No matter what we do, time marches on. We should embrace it, not try to turn it back.
Here's our conversation.
Host (02:45):
Healthy aging is inherently deeply interdisciplinary and your path reflects that. So I understand you double majoring in psychology and sociology and then transitioned into work with molecular and cardiovascular epidemiology, and now you're in public health and healthy aging. So, could you walk me through that transition and how you arrived at the intersection you're at now?
Allison Appleton (03:05):
Sure. Both my parents are physicians. They're both medical doctors, but both in very different ways. My father was a pathologist and really into the hard science, biological science of medicine and health and healing. And my mother was a psychiatrist and thinking about mental health and adversity and stress and how all of that mattered for people's lives, not only their mental health, but also their functioning. So I think those two pieces influenced me and I think I've carried that through. I started as an undergraduate major in psychology and there I learned about developmental processes from childhood to adulthood to older adulthood. I did double major in sociology where you learn about macro level social processes and institutions and how those social structures influence behaviors and pretty much everything in our life. So from there I went on to get first my master's of public health.
So again, thinking about the social determinants of health and how that all matters for health and functioning. I continued with those themes as a doctoral student and there I really got into epidemiology and my emphasis area is in social epidemiology. So again, social determinants of health, thinking about how psychological processes and stress really matter for health, not only in the moment, but how does that matter over time for our physical health? I did do a postdoctoral fellowship in cardiovascular epidemiology, so that's where I really learned the ins and outs of cardiovascular diseases. So, my research has really focused a lot on understanding the role of adversity and how that matters for cardiovascular disease, not only cardiovascular disease, but a lot of my work is in that space. One thing that I've spent a lot of time in my work, both as a student and as a trainee and now as a professional, is thinking about the mechanisms that link experiences of adversity to the morbidity and the mortality that we see at the end of life.
Things like the behavioral pathways and also the physiologic pathways that might link experiences of adversity early on to later life health.
Host (05:07):
Earlier this year, you assumed the position of director for the UAlbany Center for Healthy Aging. And so I'd like to kind of start out with a big question, which is what is healthy aging and how is it different from longevity?
Allison Appleton (05:20):
Longevity is the length of life. So that's how many years a person lives. So we're talking about numbers. Healthy aging is more about how well we live as we get older. So not simply how long we live, but the quality of those years, what's happening as we age. And what I also want to point out is that healthy aging doesn't just mean that we're trying to avoid disease or avoid disability, that you can't have healthy aging if you have those things. And that's really not true. People can live with chronic conditions and still age really well, maintaining function, autonomy, those meaningful relationships, quality of life. So we're not talking about the absence of disease and disability as we age. We're talking about enhancing quality of life during the years that we have.
Host (06:05):
For someone who's just optimizing for longevity, and there are so many articles and stories out in the world about you take the supplement or biohacking, all these different ways to just live longer, if that's the focus, what are people missing that healthy aging would better take into account?
Allison Appleton (06:22):
So some of the most important influences on aging aren't necessarily found in a supplement or routine. They're things like our relationships, our social environments, our physical environments, our access to resources, our access to healthcare, the opportunities we may or may not have in a life that's going to make healthy aging easier or make it a bit harder. So those are the kinds of things that really matter for promoting healthy aging. I would never tell somebody to not take the steps or supplements or so forth, but I'd encourage people to be reflexive and ask a bigger question as they engage in those behaviors. What are you after? What do I want those extra years to look like? And am I doing what it takes right now to make that possible?
Host (07:09):
How can something that happens in childhood become biologically embedded and then influence something like say a cardiovascular event decades later?
Allison Appleton (07:18):
Childhood adversity, this includes things like abuse, victimization, neglect, household dysfunction, a number of difficulties in early life. More adversity in childhood increases the risk for a number of diseases later on in life, including cardiovascular disease. So a lot of research has gone into understanding how does that happen? What's most easily understood is what we call the behavioral pathway. So kids who experience adversity growing up might develop health risk behaviors like smoking or drinking or dietary behaviors in part maybe to cope with those adversities early on. And the uptake of those risky behaviors may stay with you over time and contribute to something like cardiovascular disease. So that's the behavioral pathway. The other way we think about how something like adversity can become biologically embedded may be operating through what we call the physiologic pathway. The body has a number of important mechanisms that help us mount a response to a stressor, so your fight or flight system.
It allows us to combat stress when we meet it in an acute setting. However, in the situations of chronic stress or in someone who experiences trauma or victimization, that stress response system doesn't always terminate. So it may continue to be active, continue to have downstream effects like continuous secretion of cortisol and stress hormones that over time can contribute to wear and tear in our body systems and again, contribute to something like cardiovascular disease risk later on.
Host (08:45):
I know that you're involved deeply obviously in child and maternal health. What are some of the approaches or interventions that you've seen that might be able to sort of help some of those trust responses if they manifest in children early in life?
Allison Appleton (09:01):
If you can put supports around people who may be coming in to a particular experience with an adversity history, putting social supports in place, adding positive factors can offer a buffer to push people into a different trajectory than they may otherwise have been given they didn't have that social support. I mean, you can't undo a life history of trauma or victimization, but you can with a trauma informed approach, support people in a way that may give them what they need to get onto a healthy trajectory.
Host (09:33):
For someone listening to this who might be at or approaching or beyond midlife who's maybe been exposed to some of these things and has this as part of their history, is it too late? Are there interventions that can happen later that can be effective and help someone with those experiences lead a healthier later life?
Allison Appleton (09:52):
Absolutely. I think one of the most important messages from a life course perspective, which is what I'm speaking about, is that it's actually never too late to influence healthy aging or to come back from something that's difficult. I mean, it's kind of the beauty of human physiology. We are extremely malleable. So what happens in childhood matters, but what happens in middle adulthood, what happens in older adulthood matters too. So I think what people should keep in mind is that our experiences, environments, and exposures for better or for worse, can accumulate over time and shape our health together. It doesn't mean that once you reach midlife, that your trajectory is set in stone.
Host (10:28):
Looking at some of the work that the Center for Healthy Aging is working on now, we know that nationally, globally, certainly in New York State, our population is aging. If we don't get healthy aging right now, how can it affect healthcare systems, caregivers, families later?
Allison Appleton (10:48):
First is I think what's really important, and I'm glad the Center for Healthy Aging is able to step into this space, is that kind of acknowledging that aging is not a one discipline specific problem to be solved, that everybody coming together from across disciplines needs to be at the table, both academic researchers and community partners from a range of spaces to address this aging and our population together. There's pressure on our healthcare systems. In New York State, I think we are fourth in terms of having the oldest population out of all 50 states. So we have an aging population in New York, and I think globally the number of older adults over age 80 is expected to triple by 2050. So we have to be ready to meet the needs of this population in terms of their own health and their own aging needs, but also our healthcare systems, our social service systems, our communities need to have the tools and resources that they need to effectively manage what's already coming our way.
That pressure doesn't just stop at our healthcare systems and our social systems and communities, it goes and trickles into the lives of families and caregivers as well. What we really want to do is make sure we're taking a holistic interdisciplinary approach, not only to research to kind of break new ground and have research innovations and drive the field forward, but importantly, translating those research innovations to practice so that our systems aren't going to be overburdened and they can be ready to meet the demand. And working at an institution like UAlbany where we have this real strong connection to our community partners and also by virtue of being in the capital district where policy is made, I think we're well positioned to contribute in the ways that we need to, to be ready for what's already happening, the aging population in New York.
Host (12:39):
I'm curious about some of the tools or approaches that you're most excited about in healthy aging right now. And with this, I also want to ask about artificial intelligence, which is of course everywhere. It's a part of every conversation now, and I'm wondering about the promise it holds for this space.
Allison Appleton (12:56):
Yeah, sure. AI is everywhere and it's already transforming our lives, whether you're thinking about aging or not. And I think the promise of AI in healthy aging is its ability to help move us from maybe a general one size fits all approach to something that might be more tailored to the needs of older adults. There's been a real interesting explosion in what's called conversational companions. So one problem that is common among older adults in the aging population is loneliness and social isolation. And these conversational companions are technology where you can engage in conversation, you can have that kind of feeling of a companion and having conversations. So there's the LQ robot, which is a tabletop device that will proactively initiate chats with you so that you feel part of something. Another problem in the aging world that AI is making inroads is related to falls and frailty.
So you see these risk detection tools coming into play where there's wearable technology and passive censoring in a room or in a bed or in a floor that can detect changes in people's movement, trying to get ahead of somebody reaching to the point where they might have a fall. Those are just two examples where you see AI making some inroads and some of the major problems that we think about in aging, loneliness and in falls and frailty. At the center, we are also working in this space. We have some research collaborations, for example, with an industry partner who has developed a voice assisted AI platform to help facilitate discussions between patients, their caregivers and providers about making decisions around end of life care. They're difficult conversations to have. Understandably, families and caregivers might not feel ready to have those decisions. The consequence of that though is that sorts of supportive services that are available at the end of life, you have delayed access and you might end up in hospital where you want it to be home, for example, at the end of life.
Host (14:56):
So for someone listening now who might be thinking about things that they can do to lead a healthier life, no matter what age they are right now, what's one of the top things that you'd want someone to start doing or start doing differently or consider to have a path towards a healthier life later?
Allison Appleton (15:14):
Physical activity is only good, whether you're talking about making your body stronger, which we need to be stronger as we age, physical activity can also promote mental health. It also can facilitate social engagement if you go for a walk with somebody. So I think physical activity is kind of top of the list. And I think going along with that is you may not think of maintaining healthy social relationships as key to your physical health, but it really truly is. It's really just as important as making sure you go to your doctor once a year, having those relationships and nurturing them over time really matters for physical and your mental health as you get older.
Host (15:49):
Something that comes up in the healthy aging conversation is this idea of an epigenetic clock. And I'm wondering what that is and also what it can tell us that chronological age doesn't.
Allison Appleton (15:59):
Sure, that's a great question. So if you think of an epigenetic clock, you can think about it as a kind of a speedometer for aging. So where chronological age is based on your birthday, an epigenetic clock reflects how the body is aging during those years. So is aging accelerated? Are you biologically older than what we'd expect given your birthday? So if you think about when you see someone you haven't seen in a long time and you think to yourself like, "Wow, that person looks really old for their age," or conversely, "Oh wow, that person looks really young for their age." This is the concept that epigenetic clocks are trying to estimate, but with data. It's looking at patterns of chemical marks on your DNA. So DNA methylation, these are methyl molecules that adhere to the cytosine sites of your DNA double helix. And the amount of methylation that we have in our DNA changes as we age.
It's normal, it happens, we expect it. What's also happening though is methylation can change in response to diet, smoking, stress, pollution. And so the patterns of this DNA methylation that we can observe across many places in the genome can provide us with an estimate of our biological age. You expect your age to predict mortality risk, it does, but these molecular markers can actually enhance the prediction of mortality risks. That's why people are pretty excited about it from a research standpoint. From the clinical standpoint, it's really early days to see how and in what ways epigenetic clocks can be useful for clinical medicine diagnostic tools or to guide clinical decision making. But certainly from a research standpoint, the population-based standpoint, it has interesting and important utility to discriminate risk in the population in a way that chronological age is just different. I think of epigenetic age and epigenetic clocks as instructive and informative tools to use in research to leverage the vast amount of genomic data that we have to kind of distill into these measures that can provide insights.
I think that's the utility of these tools, these algorithms to predict epigenetic age. They're taking a ton of information and winnowing it down into one variable that you can say, "My age is this relative to my chronological age." So that's the utility of it in research.
Host (18:20):
What's a common misconception about aging research that you'd like to correct?
Allison Appleton (18:25):
The largest misconception is that aging is something to be feared or that getting older automatically means you're going to become sick, frail, or just less capable. We focus too much on what people might lose as they age, that we overlook what we actually gain as we get older. And I think that's the reframe we really need to be emphasizing. So getting older can bring strengths, things like wisdom, experience, perspective, emotional maturity, deeper relationships. There's a lot that comes with aging that's important. Also, people continue to learn and contribute and be creative and find purpose. We don't really shine a light on that the way that we do for other life phases. Aging is not a disease to be cured. We're all aging and it can lead to beautiful things at a different phase in our life.
Host (19:14):
That was Allison Appleton, director of the Center for Healthy Aging and Associate Professor of Epidemiology and Biostatistics at the College of Integrated Health Sciences. If you want to learn more about Allison's take on balancing digital privacy with technologies that could truly help people, check out the longer version in our show notes. There, you'll also find the latest on UAlbany's Internships and Aging Project, a signature program designed to prepare students for professions working with our aging population.
If you missed last week's episode with UAlbany criminologist Jim Acker on the resurgence of capital punishment in the US, be sure to give it a listen.
The Short Version would not be possible without contributions from many people, including for this episode, Scott Friedman, who provided audio production and editing from the UAlbany Digital Media Studio deep inside the podium tunnels. We'll be back next week with another short conversation about something interesting.
I'm Erin Frick here at the University at Albany, and this has been The Short Version.