Ara S. Khachaturian
Corresponding Author: Ara S. Khachaturian, Editor-in-Chief, Rockville, MD, USA, Tel.: 1-301-309-6730, Fax: 11-301-309-6724, E-mail address: ENC_JARLIFE@kra.net
J Aging Res & Lifestyle 2023;12:1-3
Published online April 5, 2023, http://dx.doi.org/10.14283/jarlife.2023.1
This editorial describes the priorities of the Journal of Aging Research and Lifestyle [JARLife] for 2023. The aim is to provide a brief overview of the opportunities and the challenges in the development, deployment and implementation for research focused on clinical health services and novel models of care for people with various types of chronic disorders, including those conditions that affect memory, movement, and mood. JARLife promotes the communication of research findings that examine the complexities of validating well-integrated continua of care programs—or interventions—that are effective, affordable, and widely accessible for people with various forms of chronic disorders often associated with aging adults.
The Journal recognizes the unique challenges for prolonged care and the development of clinically meaningful interventions posed by many chronic disabilities. In this way, the Journal seeks to publish a wide range of research topics on comprehensive solutions that would ensure a) universal accessibility to appropriate and effective interventions, b) improvement of overall health outcomes and/or clinically meaningful results and, c) maximizing autonomy, independence, and quality of life. The crucial dilemma of primary caregivers stems from the uncertainty of how to identify and select among the many options for care/therapeutic interventions amid continually changing conditions. JARLife seeks to help answer the following question for the patient and the caregiver: what are the appropriate interventions for the here and now?
The fundamental premise for the Journal’s editorial priority is to answer the so what question. The editors’ criteria for qualitative evaluation of prospective manuscripts includes the query of whether a given paper will have a significant impact on maintaining, prolonging, optimizing or improving independent functioning and/or quality of life for as long as possible.
The problem
One of the unintended consequences of the longevity revolution is the increasing numbers of people impacted by some form of chronic health disorder, neurodegenerative disease, or cognitive/behavioral/functional impairments. Although the origins and underlying biology of these disabling conditions vary, they share some clinical features that require similar health care services. Among the shared aspects of many long-lasting chronic diseases, the most urgent dilemma is the growing demand for prolonged care, which is often personalized, labor-intensive and costly. The necessity for long-term care for protracted health disorders is a global public-health problem and a major influential factor for the pending insolvency of healthcare financing systems.
Some of the other common characteristics of many of these disorders include:
• Long-drawn-out progression with uncertain origins but now known to include decades-long asymptomatic-preclinical period before the expression of any detectable signs of the disease.
• Heterogeneity in the age of onset, as well as on expression of behavioral, clinical, and pathological features.
• Risk factors that may include family history, genetics, comorbid conditions (e.g., vascular disorders) and lifestyle.
• Clinical-behavioral phenotypes that may entail, a) progressive cognitive impairments, b) neuropsychiatric symptoms such as—agitation, sleep disorder, personality, hallucination etc and c) psycho-social changes.
• The increasing need for demonstrable effective treatment and care interventions.
In view of the positive outcomes of behavioral interventions, the primary editorial focus of JARLife is to consider the challenges and opportunities for developing well-integrated care interventions to prevent or ameliorate the behavioral correlated (for example) of neurodegenerative disorders. The major challenges for developing effective or clinically meaningful care interventions for people with chronic disorders stem from the uncertainty of knowledge on:
• Often the underlying pathobiology of disease presents a substantial challenge in providing effective integration of care interventions. Accurate diagnosis is essential for ensuring that people with chronic conditions receive the best care, yet numerous existing diagnostic tools are either costly or inaccessible. In addition, there is still limited understanding of the underlying causes and mechanisms of many of these diseases which has hindered progress in identifying reliable clinical health outcomes for early diagnosis. Often clinicians must rely on the patient’s self-reported symptoms and medical history when making a diagnosis. This lack of precise information about the condition can lead to misdiagnosis and inadequate treatment plans. To address this issue, further research is required to identify more effective biomarkers—or clinical health outcomes—and diagnostic techniques as well as to investigate the underlying causes of many chronic disorders.
• Care programs for chronic conditions that arise from polygenic factors or complex pathobiology require collaboration between numerous stakeholders. To ensure that individuals living with these conditions have access to accurate diagnosis, appropriate treatments, and necessary support services, further research on biomarkers and causes must be conducted to provide more reliable diagnostic instruments and improve understanding of the condition.
• The marketplace of services and interventions presents another challenge to providing effective care for people with chronic disorders. Many individuals living with such conditions require a variety of healthcare, social, and psychological services to manage their symptoms, yet access to these resources can be difficult due to financial and geographic barriers. Additionally, clinicians may not be adequately trained or equipped to provide care for patients, for example, neurodegenerative brain disorders coupled with vascular and metabolic disorders, which further complicates the task of providing adequate treatment. To address this issue, there is an urgent need for improved coordination between health systems, public agencies, and private organizations such as specialized care homes and respite centers in order to ensure that people with multiple chronic disorders have access to the necessary services and interventions.
• Unknown options and approaches that may promote successful aging and maintains an individual’s personal autonomy and independence via lifestyle, architecture design and other future approaches using consumer goods, services, and technology.
• Uncertainty of finances and emotions for caregivers is yet another issue that needs to be addressed. Caring for someone living with a complex admixture of chronic disorders can be emotionally, physically, and financially draining. Caregivers often struggle to obtain adequate support due to limited resources or fear the burdening of providing care. To ensure that individuals affected by these conditions get the best possible care, it is essential that there are adequate financial resources available to help cover the cost of care as well as the emotional support systems to alleviate, burden and isolation associated with caregiving.
Clinical Meaningfulness
The concept—value of knowing—is essential to understanding the importance of diagnosing and treating people. By having a diagnosis, individuals have access to treatments and interventions that may slow the progression of their condition, as well as to specialized support services and resources. Additionally, families can receive more accurate information about the condition and how it affects their loved one to better prepare them for providing care. The Journal will be interested to see those manuscripts that apply the Branford-Hill Criteria as an approach to evaluate the validity of clinical meaningfulness to determine whether the benefits associated with a diagnostic test outweigh its potential harms. The criteria incorporates numerous factors including accuracy, reproducibility, cost, and risk-benefit ratio in order to evaluate the potential clinical benefit of a test, helping to ensure that individuals are not harmed by unnecessary or inappropriate diagnostics. Authors are encouraged to explore these topics as a means of understanding the linkages among the components.
Continuum of Chronic Disease
Understanding and applying the concept of a continuum to chronic diseases and disorders is essential in providing appropriate interventions to persons with metabolic, vascular, movement, and cognitive disorders. Such a model helps ensure that treatment plans are tailored to meet the needs of an individual, focusing on their specific cluster of symptoms and behaviors rather than treating them as a member of heterogenous group. The continuum concept also acknowledges different stages along the course of a disorder, or disorders, which can help medical professionals better predict progression and ultimately provide more effective care, treatment, and intervention options.
Furthermore, examining phenomenology of these disorders such as impact on self-awareness, interpersonal relationships, functional capacity, social roles, spiritual values, emotional stability, and physical well-being is an important part of diagnosing and managing neurodegenerative conditions. By considering all these aspects when designing treatments and interventions it is possible to provide a more holistic approach that respects the person’s individuality and supports their quality of life.
Care Plan of the Future
Will the care plan of the future should focus on providing comprehensive and individualized treatment? The Journal looks forward to manuscripts explores the topics of early diagnosis, tailored interventions, ongoing support, and lifestyle modifications aimed at slowing cognitive decline and improving quality of life. In terms of detection and diagnosis, it is important to utilize techniques that have been validated as being both accurate and reliable to ensure more effective treatments. Additionally, it is important to include assessments of functional capacity, social roles, spiritual values, emotional stability, self-awareness and physical well-being in order to better understand how the disorder affects an individual’s overall functioning.
Next-generation clinical treatment plans should be tailored according to individual need with emphasis on disease management, symptom relief and lifestyle modifications. In terms of interventions, it is important to employ a variety of techniques including both pharmacological and non-pharmacological treatments such as cognitive and behavioral therapies, physical activity, nutrition counselling, stress reduction strategies and social support. Furthermore, caregivers should be involved in the development of treatment plans to ensure that they are empowered to provide ongoing support for the individual affected by neurodegenerative disorder.
The care plan of the future may include a multifaceted approach that considers elements such as early diagnosis, medical treatments, lifestyle modifications, financial assistance, and emotional support. Early diagnosis is important in order to provide individuals with the opportunity to access treatments that can slow the progression of their condition. Medical treatments may include medication, physical therapy or other interventions designed specifically for the individual based on their particular disease state. Lifestyle modifications may include changes to diet and exercise habits that are tailored to the individual’s needs and abilities. Financial assistance programs such as Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) can help cover medical costs associated with neurodegenerative disorders. Finally, emotional support should be provided through family members, friends or even mental health professionals as necessary.
The care plan of the future may also acknowledge that different individuals may require different levels of care based on their particular condition. For example, those with Alzheimer’s or other forms of dementia should receive additional support and care from family members, friends and/or organizations that specialize in providing such services. It is also important to ensure that individuals with chronic disorders maintain a level of autonomy by encouraging them to participate in activities that stimulate cognition and physical activity. Additionally, incorporating natural remedies such as meditation and yoga can be beneficial for managing the symptoms associated with neurological conditions.
The care plan of the future for individuals with neurodegenerative disorders should involve an integrated and multidimensional approach that combines evidence-based medical treatments along with lifestyle interventions. Diagnosis should include comprehensive imaging, biomarkers, and cognitive/behavioral/functional testing to identify and monitor progression of the disorder. For treatment, a combination of medication, physical therapy, speech, and occupational therapies could be used to reduce symptoms or slow their progression. In addition, complementary therapies such as music therapy, art therapy and yoga can be used for symptom relief. Care plans should also include social support to address feelings of isolation commonly experienced by people affected by these disorders. Finally, the importance of self-care practices such as regular exercise, healthy diet and sleep hygiene should not be overlooked. This care plan should be tailored to the individual needs of each person and monitored regularly by a team of healthcare professionals to ensure the best outcomes.
The Journal looks forward to authors and readers submissions and comments for new initiatives for 2023.
Conflict of interest: The author is Editor-in-Chief, and declares no other conflict of interest.