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IMMpress Magazine
ImmuneFromFriendtoFoe:InflammationanditsConsequencesinAging FunctionandAcceleratedBrainAgingLet’stalkaboutCanada’sPalliativeCare DEATH&SENESCENCE DEATH&SENESCENCE
About the Cover
This issue’s cover captures the essence of its theme, “Death and Senescence”, through a bold Halloween-esque design. Symbolizing mortality, a skeleton is ironically engrossed in reading a manual titled Secrets to Anti-Aging: How to Delay the Inevitable. This image is a visual commentary on our relentless pursuit to mitigate the detrimental effects of aging, a challenge that may (or may not) prove insurmountable.
The dark red tones saturating the cover are reminiscent of blood that sustains all humans and animals alike, representing vitality while contrasting against the inevitability of death. Importantly, the skeleton placed at the centre is the primary and sole subject of the cover. Death may be a disquieting or even frightening topic to some – yet, this cover challenges readers to confront “The Eventual End” head-on, inviting them to engage in articles that explore the theme of death and senescence from diverse perspectives.
Design notes
The design elements in this issue reflect its theme through attentive and deliberate use of color and illustration. Many articles feature rich and dark hues like purple, red, and black, evoking imagery of blood, the somberness of death, and even the festive yet haunting atmosphere of Mardi Gras. In contrast, some articles incorporate vibrant greens and orange, which symbolize revitalizing energy, growth and rejuvenation – and thus oppose against our preconceived notions of death and aging. Such intentional utilization of colors not only represents the overarching theme but also highlights the unique tone and message of each article, overall enhancing the readers’ engagement with the topic.
-Jennifer Ahn-
EDITORS-IN-CHIEF
Karen Yeung
Meggie Kuypers
DESIGN DIRECTOR
Jennifer Ahn
SOCIAL MEDIA COORDINATOR
Tianning Yu
SENIOR EDITORS
Jennifer Ahn
Zi Yan Chen
Baweleta Isho
Manjula Kamath
Meggie Kuypers
Annie Pu
Boyan Tsankov
Deeva Uthayakumar
DESIGN ASSISTANTS
Jennifer Ahn
Zoeen Carter
Milea DiPonzio
Ash Hagerman
Baweleta Isho
Faizah (Numa) Sayeed
Karen Yeung
Tianning Yu
CONTENT CONTRIBUTORS
Jennifer Ahn
Daniah Alkassab
Manjula Kamath
Vera Lynn
Faizah (Numa) Sayeed
Jinny Tsang
Boyan Tsankov
Carmen Ucciferri
Deeva Uthayakumar
Nicolas Wilson
Tianning Yu
Adriana Zutic
FOUNDING EDITORS
Yuriy Baglaenko
Charles Tran
© 2013 IMMpress Magazine. All rights reserved.
without permission is prohibited.
Magazine is a student-run initiative. Any opinions expressed by the author(s) do not necessarily reflect the opinions, views or policies of the Department of Immunology or the University of Toronto.
LETTER FROM THE EDITORS
In order of left to right: Tianning Yu (Social Medial Coordinator), Karen Yeung (Co-Editor-in-Chief), Meggie Kuypers (CoEditor-in-Chief), and Jennifer Ahn (Design Director)
“Death is just another path, one that we all must take.” – Gandalf (The Lord of the Rings, J.R.R Tolkien)
Ageing is a natural step in the adventure of life, yet it fills many of us with trepidation as it brings us closer to the final stop of our journey – death. To close out this volume of IMMpress Magazine, we take a deep dive into the ageing process and confront the taboo topic of death. While ageing is often synonymous with decline, improving our physical and mental wellbeing can ensure that we age well. Rather than hiding away our signs of ageing, we encourage readers to embrace these marks of living life, and to celebrate the experiences and wisdom we have gained along the way.
In this issue, we examine global (p.8) and sex-specific (p.20) patterns of change in life expectancy, followed by a detailed look of how the immune system can contribute to the negative consequences of ageing (p.10), particularly in the brain (p.12). We spoke with Department of Immunology faculty Dr. Olga Rojas, who shares with us her expertise on neurodegeneration, brain health, and being resilient (p.16). We also discuss how culture shapes our perception of ageing (p.26), and how the health and beauty industries can take advantage of negative perspectives to carve out an “antiageing” market of goods and therapies (p.22). Despite the prevalent fears surrounding death as the endpoint of life, death is an incredibly critical physiological process to an organism’s development and continued health (p.24). However, we also showcase special examples of how death can be hijacked to benefit parasites at the expense of the host (p.27). Finally, we explore how the healthcare system supports the ageing and dying population through commentary by Atul Gawande in his book It’s Never Too Early to Think About Retirement (p.29), and palliative care (p.14) and Medical Assistance in Dying (MAID) legislature (p.18) in Canada.
As always, we would like to express our heartfelt gratitude towards our team of writers, editors, and designers at IMMpress Magazine who have volunteered their time to put together another amazing issue. We wish all of our readers a happy new year, and here’s to growing older and wiser!
Karen Yeung Meggie Kuypers
The Graduate Peer Support Network (GPSN) Mentorship Program is looking for motivated individuals to join our mentorship team as a peer mentor. Scan to fill out our recruitment form.
FROM THE CHAIR
Ageing well is the goal of any sensible person. But what does ageing well mean? In this issue of IMMpress, we read about the biology, psychology and culture of ageing. For me, this issue struck home for personal reasons. My 81-year-old mother moved into a retirement home here in Toronto about a year ago called “Christie Gardens”. I have observed remarkable positive changes in her physical and mental well-being over this period – she’s become Benjamin Button. Why is this? I truly believe that despite the biological processes of ageing such as DNA damage, inflammation, and skewing of immune responses (particularly in women) that we read about in this issue, the best countermeasure to unhealthy ageing is your community. My mom gained an instant community at Christie Gardens that she didn’t have in her condo complex – this has led to more flexing of her intellectual and physical muscles and has allowed her to thrive.
In this issue you can also read a profile of Dr. Olga Rojas. One of her quotes is unexpectedly consistent with the theme of this issue: “Even a negative result means something. You aren’t closing a door; you are opening many new doors that may lead to you what you are really looking for.” This is not only a healthy way to think about science, but it is a philosophy we can develop about our lives as we age. Yes, ageing can be negative. As articulated by Atul Gawande in his book Being Mortal , ageing is the “accumulated crumbling of one’s bodily systems”. But respecting one’s own aging process is key to happiness later in life. Moreover, respect for our elders is a key element to our success as a civilization. I like the idea of Japan’s annual Keiro no Hi (Respect for the Aged Day). Let’s do that here!
Enjoy the issue and may you all age well.
Jen Gommerman, PhD Canada Research Chair in Tissue Specific Immunity Professor and Chair, Department of Immunology
Why do science?
Why do science?
Life expectancy (LE) is intuitively defined by the number of years an individual is expected to live. For the purposes of this article, I mean life expectancy at birth – the number of years a newborn infant is expected to live with prevailing patterns of mortality. This is an important distinction as crude measures of LE are subject to bias based on the rates of mortality at childbirth.
Unsurprisingly, life expectancy has varied significantly through time. Even accounting for the same period however, individuals living in different countries can vary significantly in their life expectancies. We will explore some of these differences in this infographic.
Strikingly, world average LE from the paleolithic era (2.6 million – 10,000 BC) up until the 1950s remained fairly stagnant – varying from 20 – 50 years, with individuals rarely surpassing 50 years of age.
Take Europe as an example: throughout the 19th century, the United Kingdom regularly boasted the world’s highest LE, at 42 years in the 1840s and 46 years in the 1890s.
Little more than half a century later, in the 1950s, implementation of public health measures like mass vaccination campaigns and antibiotic use would skyrocket the world LE to 48 years, with European average being 60 years, and the world leader, Norway, reaching 72 years.
Today, the global LE is 73 years, with Hong Kong leading the world at over 85 years.
Did you know?
Did you know?
Alexander Fleming discovered the first antibiotic – Penicillin – in 1928. It is thought that antibiotics have increased overall life expectancy by up to 20 years.
In the United States, the LE between 1900 – 1999 increased by 30 years, of which 25 years can be attributed to advances in public health.
Lessons learned from regional variations in life expectancy through time
The rapid increase in LE among developed nations occurred in stark contrast to regions like sub-Saharan Africa, where LE remains relatively low at 61 years.
Unfortunately, the low LE of African nations relative to leading nations is due to a multitude of factors, not the least of which are factors concerning public health and infectious disease.
The heritability of lifespan is estimated to be less than 10%, highlighting the importance of environment on LE
For example, HIV/AIDS has been – and continues to be – a public health concern in the region, and at the height of its spread in the late 20th century, had decreased the LE of sub-Saharan Africans from 64 to 47 years. Fortunately, the development of antiretroviral therapy to treat HIV/ AIDS has led to a rebound in LE in this region to its current 61 years.
Did you know? Did you know?
In Botswana – one of Africa’s wealthiest countries by GDP per capita – the life expectancy in the 1990s was 65 years, but plummeted to 36 years by 2002 due to HIV/AIDS.
The remarkable increases in life expectancy over the past century underscore the profound impact of scientific advancements on human survival. From the discovery of antibiotics and the advent of vaccines to public health initiatives and disease management strategies, science has fundamentally transformed the trajectory of global health.
Apart from sub-Saharan Africa, other (albeit smaller) sub-regional variations exist in LE across the globe.
For example, on average, Eastern Europeans tend to live shorter lives than their Western European counterparts by up to 10 years. The overall LE for Eastern Europe at 74 years is comparable to South America, where the average person can expect to live until 76.
Such regional differences are caused by numerous factors including the quality of healthcare, socioeconomic status, and diet.
East Asian countries such as Japan and Hong Kong have recently surpassed those in Europe in LE, with decreased rates of cerebrovascular disease and obesity resulting from lower dietary intake of red meat and sodium.
However, regional variations in LE still exist, which highlights an urgent need for investment into healthcare infrastructure in regions with low LE. Nonetheless, continued investment in research and innovation offers promising opportunities to reduce disparities and improve lifespans worldwide.
From friend to foe: Inflammation and its consequences in aging
With age comes a myriad of mental and physical changes that no one looks forward to, such as aches and pains, forgetfulness, and dulled sens es. However, when it comes to our health, the most sinister change of all may be the increased risk of developing chronic dis eases, such as cancer, diabetes, cardiovas cular disease, and neurological disorders. The 2017 – 2018 Canadian Community Health Survey, conducted by the Government of Canada, estimated that 75% of Canadians aged over 65 years have at least one chronic disease and over 33% have two or more chronic diseases. These chronic conditions not only account for greater than 60% of deaths in the country, but also lead to significant loss in quality of life.
What exactly are the changes that occur in our body that make us more disease prone as we age? Underlying observable physical and behavioural changes, our body is also aging at the cellular and molecular level. Our immune cells are therefore not exempt from age-associated changes. In healthy, normal circumstances, our immune cells act as sentinels and caretakers of the body – they detect and eliminate dangerous compounds, prevent tissue damage, and guard against external threats like infection-causing pathogens. Yet in our aging bodies, these immune cells slowly become “senile” and start making mistakes, ultimately becoming less efficient at protecting us. Slowly but surely, these “senile”, error-prone immune cells cause low-grade, chronic inflammation, which is a strong contributor to the development of chronic diseases. Based on this observation, scientists very aptly refer to this age-associated inflammatory phenomenon as “inflammaging”.
Given the complexity of the immune system and its relationship to our overall health, simply eliminating inflammation to treat aging could lead to unforeseen consequences. While detrimental in some cases, inflammation is an essential component to our survival. Acute inflammation is critical for fighting pathogens and repairing injured tissues. In a healthy, young individual, acute inflammation involves a delicate balance between proand anti-inflammatory factors that simultaneously trigger and control the scale of the immune response. However, aging immune cells often fail to meet the metabolic demands required to maintain this equilibrium. Consequently, these aging cells tip the balance in favour of pro-inflammatory components, increasing the likelihood of chronic inflammation that persists even in the absence of infection or external threat.
Slowly but surely, these “senile”, error-prone immune cells cause low-grade, chronic inflammation, which is a strong contributor to the development of chronic diseases.
There are multiple theories that link aging immune cells to their increased propensity for triggering chronic inflammation – and some key models are highlighted here:
1. Changes to the immune cell repertoire
Our immune system can be broadly categorized into two main types – innate and adaptive immune cells. Innate immune cells survey the body in a non-specific manner and are the first to respond to a pathogen, while the adaptive subtypes develop immunological memory towards specific pathogens or insults. This repertoire of cells is constantly replenished by stem cells in the red bone marrow. As we get older, red bone marrow is progressively replaced by fat, which creates yellow bone marrow instead. This yellow bone marrow provides limited nutrients for stem cells and thereby pushes stem cells to produce more innate immune cells than adaptive. Increased production of innate immune cells is undesirable since these cells have a low threshold for activation and are the main drivers of chronic, low-grade inflammation.
2. Oxidative Stress
Excessive stress for prolonged periods of time is also an activator of immune cells. This includes oxidative stress within cells. As mitochondria become less efficient with age, they produce less usable forms of energy, such as ATP, and more potentially harmful byproducts, like reactive oxygen species, which can accumulate in our bodies over time and activate immune cells.
3. DNA Damage
At the ends of our chromosomes exist structures made up of DNA and proteins, called telomeres, which protect the chromosome ends from getting damaged and are required for cell division. Over time, the shortening of telomeres and the accumulating mutations in our chromosomes result in DNA damage accumulation, including in immune cells, which triggers a DNA damage response that also results in inflammation.
4. Altered ability to recycle cellular machinery
Under healthy circumstances, innate cells are responsible for eating and recycling potentially harmful or damaged components circulating throughout the body, including dying or cancerous cells. Similar to how we experience wear and tear at the organ and tissue level, innate cell machinery also experiences wear and tear. With age, cells lose their recycling capacity, which leads to an accumulation of toxic substances in our body and thereby activating inflammatory mechanisms.
Lifestyle interventions hold promise in counteracting inflammaging and can promote healthy aging that prolongs life and delays the onset of disease. For example, exercise can serve as a natural anti-inflammatory remedy by reducing stress and promoting healthy metabolism. A healthy diet – consisting of foods high in antioxidants and low in saturated fats – paired with moderate restriction can also limit inflammation. Diet can achieve these benefits by promoting healthy metabolism of immune cells and maintaining a diverse gut microbiota that produce anti-inflammatory metabolites. Studies involving individuals who have lived past 100 years have provided valuable insight into the efficacy of such interventions and validate that longevity can co-exist with inflammaging if accompanied by appropriate anti-inflammatory mechanisms.
All in all, inflammation is a key driver of aging, age-related disease, and subsequent death. Anti-aging therapies and prevention of immune cell aging remain active and rapidly growing areas of research. However, while certain interventions may delay the effects of inflammaging and promote longevity, there does not yet exist a cure for aging itself or age-associated chronic diseases. Until such a breakthrough is made, and we discover the so-called “Elixir of Life”, we can only ask ourselves: “Will our immune system, which has been protecting us throughout most of our lives, ultimately lead to our demise?”
- Deeva Uthayakumar
Immune Function and Accelerated
The nervous system governs our perceptions of reality, interpreting sound, light, and other physical stimuli through sensory organs. While these organs are efficient, they are inherently limited. Sensory organs allow us to construct a functional understanding of the world, but as we age, their gradual deterioration results in perceptual deficits, reduced cognitive function, and, in some cases, significant neurological challenges. While this decline is an expected part of aging, researchers have discovered that factors linked to the immune system can accelerate this process, contributing to a phenomenon referred to as “accelerated aging”.
So, what exactly is accelerated aging? Accelerated aging is defined as the set of mechanisms that cause biological aging – marked by the accumulation of cellular and DNA damage – to outpace chronological aging which refers to the number of years a person has lived. Various factors, including genetics, lifestyle, and environmental exposures, have been shown to accelerate this process. This raises an important question: how do the immune system and brain health influence accelerated aging?
Immunity and brain health are interconnected through a network of chemical signals and physical barriers that separate neural immune cells in the central nervous system (CNS) from systemic immune cells in the periphery. This separation is essential for maintaining homeostasis in the CNS, as systemic immune cells often exhibit pro-inflammatory traits that can damage delicate neural tissues within the nervous system. However, as the immune system ages, its balance with the CNS becomes increasingly fragile. Factors such as stress or inflammation can disrupt this equilibrium, which can ultimately impact biological aging.
Clinical studies investigating the role of stress on psychiatric health have demonstrated that mental health may be influenced by changes to the aging immune system. Several studies have conducted investigations to determine the relationship between immunity, brain health, and aging, given the limited understanding of molecular factors underlying many psychopathologies.
To examine this relationship, let’s explore specific mental health stressors or conditions that are influenced by such processes described above:
Social Stress
Researchers at the University of California, Los Angeles recently assessed 5,500 individuals to investigate social stressors (e.g., discrimination, trauma, etc.) and the effect they have on immune cell populations. Analysis of peripheral blood mononuclear cells, particularly T cells, revealed an increase in aged phenotypes incapable of adapting to new immune challenges. Regardless of controls for specific participant characteristics like education or smoking status, T cells were always shown to lack adaptability in individuals who faced high levels of social stress. Hence, exposure to social stressors can induce changes to T cells mimicking those created by aging and may ultimately impact brain health.
Accelerated Brain Aging
Depression
Immunosenescence refers to the gradual decline of immune function leading to chronic, low-grade inflammation, typically as a function of aging. Likewise, the aging CNS experiences breakdown of the blood-brain-barrier, which normally prevents systemic immune cells from accessing the brain. The combination of these effects has been studied, showing they may be related to the onset of depression. Morimoto and Alexopoulos (2012) studied immunity, aging, and geriatric depression, finding that aging disrupts communication between the peripheral and CNS-resident immune systems. This disruption promotes the production of pro-inflammatory phenotypes in the immune system in both the periphery and in the CNS. Quantification of these effects via cytokine analyses, neuroimaging, and electrophysiological analysis has corroborated these findings, showing that immunosenesence may be a direct causative agent in geriatric depression.
Other Psychopathologies
Clinicians diagnose psychopathologies using the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual provides clinicians with the range of symptoms expected in individuals with mental health concerns using specific behaviors, patterns of thought, and frequencies to ascertain whether an event is acute or chronic. While diagnostic criteria are primarily rooted in behavioral sciences, immunological research has found associations between such pathologies and immunity. For example, Chen et al. (2024) explored whether psychosis may be related to accelerated aging, specifically inflammaging—chronic, low-grade inflammation that appears with age. Chen suggests that much more research needs to be conducted, but developmental factors may attribute to a varied immune repertoire, increasing the risk of psychosis.
The immune system plays a central role in shaping brain health throughout the aging process, particularly from the perspective of mental health and stressors. As we age, the delicate balance between systemic and CNS immune responses becomes increasingly fragile, creating a pathway for inflammation and neurodegeneration to take hold. Understanding these interactions is critical for developing strategies to combat accelerated aging and improve quality of life in aging populations. Such research has not only expanded our understanding of the aging process, but also how such processes influence our mental health, possibly even expanding the potential for therapeutics within the field of psychiatry. By addressing both immune and mental health factors, we can take significant steps toward preserving cognitive and emotional resilience in later life.
- Nicolas Wilson
Let’s talk about Canada’s Palliative Care
But First, Why Palliative Care?
In 1974, Canadian surgical oncologist Dr. Balfour Mount introduced the term “palliative care” to describe the specialized practice he established at Montreal’s Royal Victoria Hospital to support terminally ill cancer patients. Dr. Mount drew inspiration from the work of Dr. Elisabeth Kübler-Ross, an American psychiatrist who emphasized treating dying patients with dignity, respect, and open communication. Before their efforts, the medical culture of the 1950s and 1960s often excluded patients and families from decision-making, disregarding their values and preferences. Physicians rarely disclosed the realities of failing treatments and frequently neglected effective pain and symptom management, leaving patients to suffer needlessly.
Palliative care sought to reverse these cultural norms. Its primary goal was to improve the quality of life for patients with terminal illnesses, which are incurable and lead to death. Five decades later, palliative care continues to fulfill this core mission for patients with various life-limiting conditions, including but not limited to, cancer, advanced lung, heart, or neurological diseases. As a recognized medical subspecialty, palliative care is intended to alleviate pain and physical symptoms while address
ing emotional, psychological, social, and spiritual needs. It is delivered in various settings, including homes, hospices, long-term care facilities, and hospitals. Additionally, it extends support to caregivers, offering bereavement counseling and fostering open conversations about death and grief. Most importantly, it places patients and their families at the center of decision-making, respecting their values and priorities when developing treatment plans.
A Canadian Problem
The benefits of palliative care are well-documented. A 2010 study observed that lung cancer patients receiving early palliative care alongside standard cancer treatment experienced fewer depressive symptoms, improved quality of life, and longer median survival compared to those receiving standard care alone. Similarly, a 2014 study found that patients with congestive heart failure who received integrated palliative care reported greater symptom relief, enhanced quality of life, and fewer hospital readmissions than those receiving standard care. However, despite its recognized benefits and Canadian origins, palliative care is not equally accessible to all Canadians. A 2023 report by the Canadian Institute for Health Information (CIHI) highlighted inconsistencies in the availability, quality, and timeliness of palliative care across the country, revealing systemic
barriers that exacerbate these disparities.
One major challenge lies in the division of healthcare responsibilities. Since palliative care falls under provincial and territorial jurisdiction, its cost and quality vary widely across Canada – disproportionately affecting those who rely on affordable care. For example, the British Columbia (BC) Palliative Care Benefits allow BC residents of any age to access free palliative care upon diagnosis. If they have reached the final stage of a life-threatening illness, they can receive free services, medication, equipment and supplies at home, assisted living residence, or a hospice. While Alberta offers a similar program, prescription drugs must be included in the Alberta Drug Benefit List for full insurance coverage. Moreover, certain medical supplies are either subject to coverage limits or excluded entirely, placing a great financial burden on those requiring these services. In Newfoundland, medication and equipment needed for athome palliative care are only covered for the last month of a patient’s life. Additional support services are covered for 219 paid hours during that month. For patients who outlive these timelines, Newfoundland’s Central Health advises them to consult private insurances and social agencies.
The disparities among Canadian provinces and territories are also evident in their hospital infrastructure. In August 2024, the Canadian Broadcasting Corporation (CBC) reported a case in Nova Scotia where a terminally ill patient was denied admission to a hospital with a designated palliative care unit due to staff shortages. The patient was instead placed in an emergency department with limited privacy and facilities, eventually receiving a private room just eight hours before his passing. This case underscores ongoing challenges despite Nova Scotia’s efforts to improve access – such as opening a five-bed palliative care unit at Fishermen’s Memorial Hospital in 2021. Unfortunately, Nova Scotia remains the Maritime province with the fewest palliative care beds relative to its population. This outcome is likely due Nova Scotia’s chronic underfunding for public health services, which was reported in the Canadian Journal of Public Health in 2021.
More Hurdles to Overcome
In addition to geographic location, factors such as disease type, ethnic background, and socioeconomic status present significant barriers to equitable palliative care. According to CIHI’s 2023 report, patients with cancer are more likely to access palliative care than those with other diseases. The report highlighted that patients with dementia were the least likely to receive palliative care in their final year of life, possibly due to differences in disease trajectories and the unpredictability of outcomes. Unlike many other illnesses, cancer has a relatively well-defined progression, making its palliative needs more predictable. The report also revealed that marginalized groups—including recent immigrants, people of color, First Nations individuals, and the unhoused—face disproportionately poor access to palliative care. These disparities often force affected individuals to leave their communities to access services, endure extended hospital stays, and die in facilities far from home and without adequate social support.
The Path Forward
Palliative care is essential to improving the quality of life for patients and families during life’s most vulnerable and challenging moments. However, disparities in provincial policies, hospital infrastructure, and care for marginalized groups create significant hurdles to providing equitable access. Fortunately, Canada is making slow but positive progress. In 2021–2022, 58% of those who died (89,000 people) received some form of palliative care, an increase from 52% in 2016–2017. Despite this improvement, more challenges persist. For example, many patients only access palliative care late in their illness. Across the country, eligibility requirements restrict access until patients are near the end of life and currently, half of patients die within just 22 days of being identified as palliative. Considering such challenges, Canada must improve timely access and ensure care is equitable and consistent. By doing so, the country can honor its legacy in palliative care and en sure every Canadian receives compassion ate and dignified support.
- Jennifer Ahn
Beyond the brain
Dr. Olga Rojas Insights into neurodegeneration with
Dr. Olga Rojas is a scientist whose passion for discovery and positive approach to research are undeniable. I had the pleasure of sitting down with Dr. Rojas, a professor at the University of Toronto and scientist at the UHN-Krembil Research Institute, to discuss her journey to becoming a scientist, her research on neurodegeneration, and the future of immunology in neurodegenerative research.
Dr. Rojas’ scientific journey – from medical school in Colombia to scientist in Toronto
Dr. Olga Rojas has been interested in health and science for as long as she can remember. “I did the typical thing everyone says and asked my parents for a microscope when I was maybe 6 years old. I wanted to look at the anatomy of everything,” she explained with a laugh. She began her training in Colombia, attending medical school at Pontificia Universidad Javeriana. During medical school, Dr. Rojas was introduced to flow cytometry, a technique used in the hospital to measure T cell counts and assess HIV treatment response. However, in a hospital setting, Dr. Rojas was lacking answers to the mechanism behind how these T cell counts changed. Towards the end of her medical school training, she began looking for positions that combined her love for clinical practice with the ability to answer her fundamental immunological questions. This was where Dr. Rojas met her PhD mentors – Drs. Juana Angel and Manuel Franco, medical doctors running a fundamental immunology lab at the same university where she was conducting her medical training. She knew this was the place for her.
While obtaining her PhD in Colombia, Dr. Rojas gained valuable immunological experience investigating the impact of age on the protective immunity against rotavirus – a harmful virus that infects the gut. In this position, her work focused entirely on humans. Dr. Rojas looks back on her PhD fondly, citing how rewarding this work was, but there was something missing. “I enjoy working with patients, but I struggled to understand papers which involved mice, because there was no animal facility in Colombia at the time.
This is what led Dr. Rojas to join Dr. Jennifer Gommerman’s lab at UofT, which studies multiple sclerosis (MS) using mouse models of MS. While she had very little prior experience with MS, Dr. Rojas looked onward with enthusiasm. “I had done a little with MS in humans back in Colombia, so I was excited to work on this in mice!”
I asked Dr. Rojas what the most exciting moment of her research career has been thus far. “Getting into [Dr. Gommermann’s] lab was very exciting. I was so happy to be learning new things.” Dr. Rojas also cites the publication of her post-doctoral work in Cell about the migration of immune cells from the gut to the brain as the most difficult, but also the most exciting, work she has ever done. The paper, published in 2019, used a mouse model of MS to demonstrate that immune cells can travel from the gut to the brain to suppress neuroinflammation. Since its publication, the paper has been cited over 370 times, and Dr. Rojas is proud to see that many years of collaborative effort are making such an impact.
“It has opened new avenues of immunology [research] in the brain. It is rewarding to know you can contribute to science.”
Delving into neurodegeneration
Dr. Rojas’ newfound understanding of the potential role of immune responses in brain disease inspired her to search for the underlying immune mechanisms behind other forms of neurodegeneration. “We have a lot of knowledge of the immune response in MS,” Dr. Rojas explains. “Why don’t we take all [that] knowledge and translate it to Alzheimer’s disease?” Dr. Rojas’ lab at the Krembil Research Institute is
into patients and diseases.”
“I always wanted to do animal research to then have more knowledge and tools to translate
doing just that. Using mouse models of Alzheimer’s disease, her lab focuses on understanding how immune cells from the gut can migrate to the brain to influence neurodegeneration and inflammation in the brain.
Dr. Rojas is also continually motivated by advances in neurodegenerative research. Most recently, scientists have been working to provide a detailed description of the vasculature within the brain and the meninges (the membranes that ensheathe the brain and spinal cord). There is growing evidence suggesting that immune cells outside of the brain (like from the gut) can travel to the skull, meninges, and brain and communicate with existing resident immune cells. “We still can’t imagine the impact that this will have [on research]” Dr. Rojas excitedly told me – with almost a twinkle in her eye.
Dr. Rojas acknowledged that despite these new findings, research on neurodegenerative processes is not without its challenges. Unlike other diseases that can be diagnosed early, it is difficult to detect diseases like Alzheimer’s at onset. “You have to wait until the patient goes to the clinic with clear symptoms of dementia. By that point, it is already too late to see how the disease started. We still do not have good biomarkers to diagnose Alzheimer’s disease earlier,” Dr. Rojas states. In terms of preclinical work, there is still a lack of good models for Alzheimer’s disease. There are mouse models for early-onset Alzheimer’s, but there are very few models for late-onset disease, and those that exist are still relatively new. Dr. Rojas’ lab is using these new mouse models of late-onset disease to determine how immune cell migration from the gut to the brain may vary at different stages of Alzheimer’s disease.
Advice from Dr. Rojas
Speaking with Dr. Rojas, it was clear to see the passion she has for scientific investigation. At the end of our much-enjoyed interview, I asked about any advice she may have for current immunology trainees. Dr. Rojas answered with one inspiring word: “Dream.” I was moved by the simplicity of the statement. As scientists, we often get overwhelmed with deadlines and forget why we began doing research in the first place. “Believe in yourself and know that you can do big things,” Dr. Rojas continued with a look of encouragement. “We all need to build up some resilience,” she said.
“Even a negative result means something. You aren’t closing a door; you are opening many new doors that may lead to you what you are really looking for.”
- Adriana Zutic
From Mercy To Morality
Canada’s MAID Debate and the Ethics of Choices
Medical Assistance in Dying (MAID) in Canada marks a significant change in the nation’s endof-life care, sitting at the crossroads of legal, ethical, and social discourse. In 2016, MAID was legalized following the Supreme Court’s Carter v. Canada decision. It was formally established through Bill C-14, which permitted those 18 and older with intolerable suffering and a foreseeable death to seek assistance in ending their lives. Then in 2021, Bill C-7 removed the foreseeable death requirement, allowing individuals with chronic conditions to access MAID and creating a two-track system for cases with and without foreseeable death. Starting in 2027, eligibility will extend to individuals with mental illness as the sole underlying condition, intensifying ethical debates around safeguarding vulnerable groups. This legal evolution underscores Canada’s commitment to individual autonomy. Yet it also highlights the need for compassionate frameworks that protect those at risk while balancing individual rights with social and ethical responsibilities.
“It ’s my right”
Canada’s legalization of MAID is built on the foundation of respecting patients’ autonomy. MAID enables individuals to exercise control over their end-of-life choices, prioritizing their personal values and preferences. While autonomy is a fundamental right, the decision-making capacity of the individual must be carefully assessed, considering any mental health issues or cognitive impairments. Importantly, patients must give informed consent, which means they must fully understand their diagnosis, prognosis, alternatives, and the nature of the procedure while having the capacity to withdraw their consent at any time.
A qualitative study interviewed 23 patients eligible for MAID and their support persons in Vancouver, Canada in the first year after its legalization. When asked why certain patients would choose MAID over natural death or other medical interventions, the most common reason was their desire to exercise full autonomy and control over their life and suffering. Other common reasons for choosing MAID included deteriorating quality of life, decline in independence and function, and inability to participate in meaningful activity – which are all significant losses for patients who were previously independent and self-reliant. Interestingly, this qualitative study found that many patients who opted for MAID felt adequately supported by their family and friends and viewed MAID as an appropriate end-of-life care option.
Choice versus coercion
It may be challenging to secure informed consent for all MAID participants, particularly from those who are vulnerable and subject to coercion by external factors. Members of such vulnerable population may include elderly or disabled individuals, and people with mental illnesses. Social, familial and financial pressures, along with insufficient healthcare support, may lead patients to choose MAID out of guilt rather than genuine desire. Although safeguards like required written consent with a paid, independent witness are put in place, critics against MAID argue that compensating witnesses could undermine their neutrality and create financial barriers that limit equitable access.
There is also concern from the Supreme Court of Canada that MAID acts as a mere substitute for investing in essential healthcare and social services. In other words, the program
might be a cost-saving alternative to addressing systemic issues like long hospital wait times and low public health funding. The Parliamentary Budget Officer’s report in 2020 noted that 62 million CAD is saved annually from Bill C-7, fueling intense debates and speculation that MAID may be chosen reluctantly by patients as a final solution due to inadequate support.
“Primum non nocere [First, do no harm].”
- HiPpocrates
Conscientious objection - a physician’s dut y?
For some healthcare providers, the principle of “do no harm” may go against their personal, religious, or ethical values, leading them to reject any involvement in MAID. Balancing the obligate respect for patient autonomy with physicians’ rights to follow their moral beliefs is a sensitive topic. Many Canadian institutions allow for conscientious objection, permitting medical providers to refuse participation but requiring them to refer patients to another practitioner. However, critics argue that a physician’s objection could restrict patients’ access to an essential medical service. As an accessible alternative, the Canadian government has allowed patients to bypass non-participating providers and acquire MAID referrals without the need for clinicians’ approval. However, this alternative approach still creates burden on the patient to seek out a participating provider, potentially delaying access to MAID, prolonging patient suffering, and undermining the right to equitable, timely care. A more fundamental criticism to conscientious objection is that it allows publicly funded physicians to choose which lawful procedures they will provide. The practice of conscientious objection places the physician at the center of decision-making rather than the patient, instigating ethical debates about properly balancing the rights of all parties involved in MAID.
A slippery slope: what about mental health?
Expanding Canada’s MAID law to include individuals with mental disorders would raise profound ethical questions. Advocates argue that individuals with irremediable mental health disorders should have the same right to die with dignity as those with physical illnesses, emphasizing autonomy and equality. However, this expansion could expose individuals to higher risks of suffering due to social factors like poverty, isolation, or inadequate mental health care. Without robust support systems, individuals may choose MAID due to remediable conditions such as homelessness or unemployment. Ultimately, these dilemmas present policymakers with the challenge of protecting vulnerable individuals from transient distress while respecting their rights.
Another ethical issue in broadening MAID eligibility is its potential impact on mental health stigma and quality of care. Allowing MAID for those with mental health disorders could unintentionally reinforce the perception that certain conditions are untreatable, potentially eroding trust in mental health care. It could also discourage the development and delivery of improved treatments or support mechanisms. Healthcare professionals who support MAID could undermine therapeutic relationships by inadvertently conveying hopelessness to susceptible patients. The need to protect individuals from systemic failings while respecting their autonomy highlights the importance of cautious policymaking that centers on the well-being of vulnerable individuals.
Final Comments
Medical Assistance in Dying (MAID) in Canada presents a complex ethical challenge of respecting patient autonomy while protecting vulnerable populations and acknowledging professional responsibilities and societal values. This evolving practice requires ongoing dialogue and legal refinement to uphold ethical standards within a framework that respects individual rights and public safety. The ongoing shifts in MAID policies reflect Canada’s efforts to carefully integrate end-of-life autonomy with essential safeguards. In the coming years, we anticipate further discourse and adjustments as Canada navigates this intricate issue.
- Jinny Tsang
- Baweleta Isho
Sex differences who has
Sex hormones constitute another key biological factor that impacts the aging process in males and females. The main sex hormones are testosterone, estrogen hormones (estradiol, estriol, and estrone), and progesterone. Testosterone is abundant in males, while estrogen and progesterone are mainly found in females.
How can having differing sex hormones dictate how we age? As males and females age, changes in their sex hormone levels occur, which may result in negative health effects. Females normally undergo menopause in their 40s or 50s, due to a decline in production of estrogen and progesterone. During this time, there is a decrease in muscle mass, strength and bone mass density, and an increase in visceral fat. Reduced muscle strength can cause general mobility impairments, such as difficulty getting up from sitting, climbing stairs, and walking.
Before menopause, females are less likely to develop CVD, which is the leading cause of death worldwide. This is partly because estrogen plays a protective role against CVD. Estradiol has been found to increase the development of new blood vessels referred to as angiogenesis, vasodilation, and decrease fibrosis, which is the scarring of tissue. Once menopause occurs, the decline in estrogen is linked to an increase in CVD risk in females.
Males also have a decline in testosterone in andropause, which is the male equivalent of menopause. However, this decline in sex hormones is much less drastic than in females, with there normally being a 1% decrease per year. In males who are older than 60, relatively lower testosterone levels are linked to a higher chance of developing osteoporosis, rapid loss of hip bone density, as well as hip and nonvertebral fractures. Low testosterone levels also cause a decrease in muscle mass, leading to a decline in muscle strength. This results in multiple health complications, including balance disorders, an increased risk of falling, obesity, and type 2 diabetes.
differences in aging: it better?
Additionally, sex hormones impact immune function. Females tend to have stronger innate and adaptive immune responses in comparison to males. This results in females being better prepared to tackle pathogens. For example, compared to males, females have a superior antibody response to antigens, as well as a greater number of B cells. However, this heightened immune activation is a double-edged sword, also rendering females more susceptible to developing autoimmune diseases, such as the chronic neuroinflammatory disease, multiple sclerosis.
Sex-specific patterns exist in other age-related diseases as well, such as in Alzheimer’s disease (AD). AD is an irrecoverable disease where brain cells are slowly destroyed, resulting in memory loss and cognitive decline. Around two-thirds of Americans who have AD are females. There are differences in the pathology of AD between sexes. Studies have found that females have a greaterloss in brain volumeand a larger decline in cognitive function. An important risk factor for AD is the expression of the apolipoprotein E4 gene (APOE4), which generates a protein involved in cholesterol transportation. Females with APOE4 tend to have a higher risk than males expressing APOE4 of developing AD.
Another notable age-related disease is osteoarthritis, where there is irreversible degeneration of the cartilage that cushions the ends of bones inside joints. This condition usually affects joints in the knees, hands, hips, and spine, causing pain, swelling, and joint stiffness. This disease is more prevalent, and with higher severity, in females. Many women start developing age-related disease symptoms after menopause, which could be linked to the decrease in estrogen that occurs during this period.
Given that all these negative health outcomes are more common in aging females versus males, it seems that females suffer from greater rates of disability and worse health as they age, despite, on average, having a longer life expectancy than males. This phenomenon is referred to as the male-female health-survival paradox. Males are normally healthier than females at the time of death, despite dying younger. Further research on how each sex ages and develops diseases will allow for more targeted approaches to ensure healthy aging and longevity in the entire population, while delaying onset of debilitating diseases.
- Faizah (Numa) Sayeed
Unlocking the Secrets of Anti-Aging Products and Therapies for Youthful Vitality
Every year, people come together to celebrate the cherished occasion of their birthday—a day often filled with joy and anticipation. In the earlier stages of life, such as turning twenty, this milestone is eagerly awaited, symbolizing growth and endless possibilities. However, as the years go by, birthdays can take on a more bittersweet tone for many; milestones like forty, fifty, or sixty may bring concerns about wrinkles, greying hair, and other visible signs of aging.
Aging is a natural and complex part of life, marked by cumulative biological and physiological changes that gradually diminish the body’s ability to maintain balance and repair itself. This decline not only serves as a significant risk factor for chronic diseases, but also carries a psychological burden, often impacting confidence differently in men and women. Men tend to focus on the loss of physical strength and stamina, whereas women often worry about the physical markers of aging, such as wrinkles, sagging skin, and grey hair.
While aging cannot be stopped, modern science has made remarkable advances in slowing its visible and internal effects. From developing skincare serums to cutting-edge regenerative medicine, the anti-aging industry offers a broad spectrum of solutions aimed at preserving youthfulness. These efforts are often targeted more towards women, who tend to hold a more negative view of aging due to societal expectations and the emphasis placed on physical appearance.
THE BIOLOGY OF AGING
Various cellular and molecular mechanisms govern the multifaceted process of aging including telomere shortening, cell senescence, mitochondrial dysfunction, and DNA damage. Cell regeneration is mediated by the ability of cells to divide. With every cell division, the protective caps at the end of chromosomes, called telomeres, become shorter. Once telomeres reach a critical length, cells enter a state of cellular senescence, which halts their ability to divide.
Senescent cells release inflammatory molecules that damage surrounding tissues. Concurrently, mitochondria, the cell’s energy powerhouses, will experience dysfunction. This can cause mitochondria to lose efficiency, leading to reduced energy production and increased generation of reactive oxygen species (ROS). These harmful ROS contribute to DNA damage, which accumulates over time, disrupting vital genetic information needed for proper cellular repair. Together, these mechanisms lead to a cascade of cellular decline and decreased regenerative ability, laying the foundation for age-related changes.
COMMON ANTI-AGING PROD-
UCTS: SKINCARE AND MORE
We have all seen advertisements of magic creams and serums that promise to make your wrinkles disappear. These products are not only targeted towards the aged but also towards youth. Such products encompass a range of innovative solutions designed to prevent and combat the visible and internal signs of aging. Skincare products encompass the majority of these efforts, with powerful ingredients like retinoids, vitamin A derivatives, that stimulate collagen production, promote cell turnover, and reduce hyperpigmentation. Hyaluronic acid is another essential ingredient that hydrates the skin, enhancing its elasticity and plumpness, while anti-oxidants, such as vitamins C and E, neutralize free radicals and brighten the skin. Niacinamide, otherwise known as vitamin B3, improves texture, reduces redness, and strengthens the skin barrier while peptides promote the production of collagen which restores the skin structure and firmness.
botulinum toxin (Botox) and dermal fillers. Botox works by temporarily paralyzing specific facial muscles, thereby minimizing wrinkles such as frown lines and crow’s feet. Dermal fillers, particularly those based on hyaluronic acid, restore lost volume and smooth out fine lines by retaining moisture within the skin. Other advanced therapies include microneedling, chemical peels, and laser resurfacing. Microneedling creates controlled micro-injuries that stimulate the body’s natural healing processes, promoting firmer, more elastic skin. Chemical peels, available in various strengths, involve the application of chemical solutions to exfoliate the skin facilitating cell turnover and reducing hyperpigmentation. Lastly, laser resurfacing targets the skin’s deeper layers to stimulate collagen production, leading to improved skin texture. These therapies, when performed by professionals, claim to combat the effects of aging.
INNOVATIONS ANTI-AGING THERAPIES
Extensive research efforts are underway to further advance anti-aging therapies, including senolytic drugs, gene therapies, and personalized medicine. Senolytic drugs are designed to selectively eliminate senescent cells, hence improving tissue function and decreasing age-related inflammation. Gene therapy, particularly utilizing CRISPR-Cas9 technology, is being explored to repair genetic damage associated with aging. Researchers have identified specific genes that when edited, can delay aging in human cell cultures and animal models, thereby offering potential pathways for extending cellular lifespan. Lastly, personalized medicine leverages artificial intelligence and genomics to tailor anti-aging treatments to an individual’s unique genetic and biological profile. By analyzing specific aging pathways, personalized therapies can optimize the effectiveness of interventions and promote healthier aging in a targeted and specific way. This customized approach represents a new frontier in anti-aging science.
Beyond skincare, anti-aging supplements address aging from within. Collagen peptides enhance skin elasticity and antioxidants, like Coenzyme Q10 (CoQ10), combat oxidative damage to promote cellular health. Besides skin concerns, hair care solutions, such as minoxidil and peptide-rich serums, target thinning hair and scalp health, further complementing the anti-aging regimen. Together, these products claim to provide a comprehensive approach to maintaining a youthful appearance.
ADVANCED ANTI-AGING INTERVENTIONS
Advanced anti-aging therapies go beyond topical solutions to include interventions aimed at reducing the visible signs of aging and rejuvenating the skin. Common injectables include
The field of anti-aging therapies has made remarkable progress, providing solutions that target both the visible signs of aging and the underlying biological processes. From cutting-edge skincare innovations to advanced medical procedures and personalized therapeutical approaches, these advancements claim to enhance quality of life by improving both physical appearance and overall well-being. When paired with lifestyle strategies such as sun protection, a nutritious diet, regular exercise, and stress management, these therapies may offer a holistic path to aging gracefully while maintaining health and vitality. However, as we embrace these innovations, it is essential to balance optimism with scientifically validated approaches, ensuring that anti-aging solutions remain ethical, realistic, and accessible to all. Above all, we must always remember that true beauty radiates from within!
- Daniah Alkassab
Cell death: the unsung hero of life
Anything related to the word ‘death’ generally has a negative connotation. However, in the context of cell death, is death really bad? Cell death is in fact, an essential and natural process crucial for maintaining your body’s homeostasis and overall health, playing a protective role rather than causing harm.
There are many ways that cells can sacrifice themselves for the good of the whole organism, and one of the key mechanisms that is critical to health is called programmed cell death. “Programmed” means that your body knows these cells are damaged and need to be eliminated. So, it manages the process of cell death from start to finish.
‘Apoptosis’ is a form of programmed cell death that happens when a cell incurs damage from senescence, stress, or injury. Apoptosis does not trigger an inflammatory response. It is a tightly regulated process that removes damaged cells, preventing them from developing into tumors caused by DNA damage that leads to uncontrolled cell division. It also avoids triggering unnecessary inflammation, which can result in symptoms like fever, swelling, redness, or pain. This process occurs daily, particularly in tissues like the skin, which is constantly exposed to UV radiation, pollution, physical abrasion, and microbial contact, necessitating a continuous renewal process to
maintain its protective functions.
There are many ways that cells can sacrifice themselves for the good of the whole organism, and one of the key mechanisms that is critical to health is called programmed cell death.
Apoptosis can be triggered by two main pathways: the intrinsic pathway and the extrinsic pathway. The intrinsic pathway is activated when cells experience internal stress, such as DNA damage or nutrient deprivation. Such stress causes mitochondria to release proteins that initiate a chain reaction leading to cell death. The extrinsic pathway starts when external signals, like Fas ligand, bind to its receptor on the surface of a cell. This binding triggers a chain reaction inside the cell that leads to apoptosis. The Fas receptor is found on many types of cells, while Fas ligand is mainly found on activated T cells. These T cells use Fas ligand to kill target cells and also to regulate their own numbers through a process called activation-induced cell death (AICD). However, some tumor cells exploit this pathway by producing Fas ligands themselves. This allows them to trigger apoptosis in T cells, protecting the tumor from immune attack and making it more difficult for the body to eliminate the cancer. What happens if apoptosis fails to remove damaged cells? Beyond the risk of tumor formation, another consequence is the development of autoimmune conditions such as lupus. When apoptosis doesn’t eliminate overly active immune cells, these cells can attack the body’s own tissues, leading to autoimmune disorders. Another example of faulty apoptosis is ‘endometriosis’,
a debilitating condition where uterine tissue grows excessively. When apoptosis fails, this tissue is not properly regulated, leading to uncontrolled growth, pain, and other complications.
agy.
Another form of programmed cell death occurs through the process of autophagy, derived from the Greek word for “self-eating”. Autophagic cell death clears out damaged cells to regenerate newer, healthier ones by recycling components from the damaged cells, removing harmful substances from outside the cell to promote health and longevity. Methods that trigger autophagy include fasting, a ketogenic diet, and exercise. Fasting is the most effective method to trigger autophagy as it forces the body to alter its energy source from glucose to fat. Although there is no direct evidence that links autophagy to weight loss, research has shown that autophagy may reduce appetite and thus indirectly support weigh loss.
Your cells are always ready to sacrifice themselves for the greater good. Truly, cell death is one of the unsung heroes keeping you alive.
While autophagy is generally beneficial for maintaining cellular health, excessive activation of this process may pose risks. For instance, research indicates that overactive autophagy can lead to the death of cardiac cells, potentially contributing to heart failure. Additionally, while autophagy may protect against cancer in some cases, certain cancer cells can exploit autophagy to support their survival and growth. Further studies are needed to better understand the complex relationship between autophagy and cancer, as well as its broader implications for health and disease.
Autophagy is a tightly regulated process that is regarded as the waste management or housekeeping system of the cell. Disrupted autophagy has been associated with conditions such as diabetes, neurodegenerative disorders, and certain cancers. In Alzheimer’s disease, for example, impaired autophagy affects immune cells in the brain called microglia, making them less effective at clearing harmful protein clumps. These protein clumps then trigger an overreaction in microglia, which begin to attack
Programmed cell death is a vital process that protects and maintains your health. Your cells are always ready to sacrifice themselves for the greater good. Truly, cell death is one of the unsung heroes keeping you alive.
- Tianning Yu
AsAging Through the Lens of Culture: How Societies Shape the Way We Age
humans, one thing binds us universally: we age. Yet societies and cultures perceive aging in profoundly different ways, shaping how we treat older individuals and view our own aging process.
With global life expectancy rising and birth rates declining, aging populations are becoming a universal reality. Currently, about 1 in 11 people (9%) worldwide are over 65, according to the United Nations. This figure is projected to increase to 1 in 6 people (16%) by 2050, representing a dramatic demographic shift. This shift demands more conversations around how the process of aging is viewed in our society, and what changes can help our elders lead a better and more fulfilling life in their later years.
Collectivist societies, which emphasize familial and community bonds, often view elders as integral members. They are valued for their role in society where they maintain continuity of traditions and provide wisdom and guidance to the younger members. Conversely, individualistic cultures may prioritize independence and productivity, inadvertently sidelining those who are perceived to not fit this description, including older individuals.
In many Asian cultures, aging is synonymous with gaining wisdom. For instance, in Japan, the concept of “kō reisha” (elderly) conveys a sense of respect and reverence. Elders are seen as keepers of tradition and wisdom, celebrated annually during Keiro no Hi (Respect for the Aged Day). In contrast, Western societies, particularly in North America, often glorify youthfulness. Terms like “anti-aging” dominate marketing campaigns, subtly (or sometimes, not so subtly) suggesting that aging is something to be resisted rather than embraced.
Mass media plays a significant role in shaping perceptions of aging. In Hollywood films such as Grumpy Old Men (1993), older characters are often stereotyped as easily annoyed, constantly complaining, and set in their own ways. However, films like The Intern (2015) challenge these stereotypes by showing a retired professional re-entering the workforce. Similarly, Korean dramas often offer nuanced portrayals of older protagonists, such as in Navillera (2021), which tells the inspiring story of a 70-year-old man who pursues his dream of learning ballet. These examples highlight the power of media to both reinforce and challenge ageist stereotypes, shaping how society views older individuals.
With a global rise in the elder population, and as economic pressures and caregiving needs grow, societies have been grappling with integrating older individuals into their frameworks. For instance, intergenerational living arrangements are resurging; the idea of living with parents or other elder members of the family seems more lucrative to all members of the family unit. Meanwhile, countries like Sweden are pioneering “age-friendly cities,” focusing on accessible infrastructure and inclusive policies to ensure quality of life for all ages. Programs which engage retirees in meaningful community work, or age-inclusive design initiatives, are steps in the right direction. They demonstrate how societies can celebrate aging as a phase of continued growth and contribution.
Not discounting these efforts, ageism, or prejudice against individuals based on their age, remains a pervasive issue. It is deeply embedded in societal structures, from workplace discrimination to healthcare biases. Tackling this challenge requires long-term cultural shifts in mindset. Promoting the idea that aging is not a decline, but a transformation can change the narrative.
As human society evolves, so do the cultural perceptions of aging. By promoting dialogue and highlighting the value of older individuals, we can let go of stereotypes and create societies where aging is not feared but embraced. Our differences make us unique and valuable members of society.
-
Manjula Kamath
Parasite-Induced Death Seeking Behavior
We’ve all seen movies or read books featuring zombies— mindless creatures driven by a singular, relentless urge. The reassuring thought is that these undead beings are purely fictional… or so we’ve convinced ourselves. In the animal kingdom, a kind of ‘zombification’ can exist in the unique relationship that occurs between a parasite and its unfortunate host.
Parasites are organisms that require a host for survival and ultimately benefit from this relationship while the host is harmed. The main goal of a parasite is to maintain their own existence and they have evolved to do this in clever ways. This can include manipulating their host, which can lead the host to death. Here are some examples of this extreme parasite induced death seeking behavior:
One of the major reasons why parasites lead their hosts to death is to complete their own life cycle, which can take place in a secondary host. Certain species of parasitic flatworms (Euhaplorchis californiensis) can enter the gills and migrate to the brains of California killifish (Fundulus parvipinnis) causing them to swim to the surface of the water. This exposes the fish to flying predators such as birds, allowing them to get eaten and happily reproduce in their new host’s small intestine. Similarly, a parasitic fluke (Dicrocoelium dendriticum) can take over the navigational be havior of ants. If an unsuspecting ant eats a slimeball secreted by infected snails, the ingested parasite will cause the ant to climb to the tip of a blade of grass instead of back to the safety of its own nest during the night. There, the ant is susceptible to being eaten by a grazing predator, allowing the parasite to continue its life cycle. Crickets are another example of this parasite-induced brain control. Once infected with hairworms (Paragordius tricuspidatus), crickets will vol untarily enter the water and drown, which allows the parasite to exit the cricket and reproduce. Clearly, parasites have become very effective at manipulating host behavior in a way that allows them to complete their own life cycle.
Parasite-induced death seeking behaviors can also occur the mammalian world. One example is the parasite Toxoplasma gondii (T. gondii ), which typically
infects cats and rodents but can also be detected in humans. In fact, it is estimated that 1-4 in 10 Canadians have been infected with this parasite. This parasite uses rodents as an intermediary host and is thought to form cysts in the brains of infected rats. These cysts occur in areas that regulate fear and can lead to a loss of fear of predatory odours that make the rodents more susceptible to being preyed upon by cats, allowing the parasite to enter its final host. Researchers are uncovering that T. gondii can alter the behavior of other warm-blooded animals to reach their final feline hosts, as well. Hyena cubs infected with this parasite show excessive bold behavior, causing them to be more susceptible to lion attacks. Thankfully, T. gondii infection doesn’t cause substantial harm to adult humans, although it can cause complications in the fetus if this infection is contracted by the mother during pregnancy.
These are just some examples of how parasites can turn their hosts into mindless zombies – many more exist that we are still learning about today. Thankfully, this interesting natural phenomenon doesn’t pose as much of threat to humans as the fictional zombies we entertain ourselves with.
- Carmen Ucciferri
It’s Never Too Early to Think About Retirement... A Book Review on Being Mortal by Atul Gawande
Despite being in my twenties, I had a bartender tell me I looked thirteen years old. To take advantage of the situation, I dressed up as Piglet from Winnie the Pooh on Halloween and went trick-or-treating to see how many strangers would give me candy without question. I got over 100 candy bars (many full sized, because wisdom gained over the years dictates that rich, elderly neighborhoods are the most fruitful). The consequences of growing old, finding a nursing home, or how the meager money in my RRSP should be spent during retirement are all fleeting thoughts that carry little weight. If anything, it is weight easily shrugged from youthful shoulders. Being able to trick-or-treat successfully at twenty-three often leads to such delusion of immortality. Having full autonomy to walk around a nice neighborhood collecting candy and making unhealthy eating choices had always been taken for granted. Then, I read Being Mortal by Dr. Atul Gawande, and I began to seriously think about death and senescence.
In this book, Gawande makes the consequences of aging in our highly medicalized health care system shockingly clear through a series of reflections and anecdotes from patients and innovative physicians alike. In our current health care system, we have come to expect cures and miracles from our physicians - popping an antibiotic can eradicate previously debilitating diseases, and a poke in the arm can prevent pandemics. But what happens when patients present with an unfixable problem?
While most diseases have a solution, it is inevitable that our bodies will grow weaker with age or illness and eventually, multiple physiological systems will begin to shut down simultaneously. This “accumulated crumbling of one’s bodily systems,” as Gawande notes, becomes too complex to fix with simple prescriptions. As the body’s machinery falls apart, no amalgamation of pills, ventilators, tubes, or injections can turn back time. Gawande points out that our blind trust in the power of modern medicine has made it increasingly difficult to accept our mortality. Patients facing the end of their lives have increased hopes that they can prevent the inevitable, gambling on the coin toss between hopeful recovery and risky operations that could lead to even more suffering. Unfortunately, as Gawande summarizes, it is all too common that “the waning days of our lives are given over to treatments that sap our bodies for a sliver’s chance of a benefit.”
In his narrative, Gawande paints a picture of our current healthcare system that mistakenly prioritizes the prolongment of biological ‘health’ at cost of the emotional ‘care’ that patients often seek. As I read on, I came to understand how poorly our society has prioritized our future. Our life expectancy has climbed to optimistic new heights but it only buys more time to be spent bedridden from an unrelenting illness or institutionalized in nursing homes with strict schedules and little autonomy. I had always considered the retired life to be an opportune time to be free of responsibilities, to pursue new hobbies, and to eat at Michelin star restaurants twice a month (provided I start saving money in my RRSP like my dad keeps telling me to).
But with every turn of the page, worries that aging meant losing the freedom to live life by my own terms began to mount. Anecdotes about senior residents forbidden from eating M&M’s for fear of choking or being told to trash their memorabilia for fear of fire hazards show the potential negative emotional consequences when long-term care facilities and caretakers prioritize safety over satisfaction. Gawande’s account of Keren Brown Wilson, a woman who wanted to create a better nursing home for her mother, emphasized a major flaw in the current system. Wilson’s mother had just one condition for her accommodation: to be able to wake up when she wanted and to have control over her own schedule. Such a simple request is often not granted, demonstrating the loss of autonomy most residents face. Through this book, readers are sure to recognize how the privilege of independence should not be taken for granted.
Despite the flaws of some nursing homes, Gawande shows that improvements are possible with some creativity. My favorite anecdote was of Dr. Bill Thomas, who expelled the gloomy atmosphere that had settled over the senior residents of Chase Memorial Nursing Home by introducing novelty into their routine. He introduced plants, children, dogs, cats, and even one hundred parakeets into the nursing home and revitalized the care for the residents of the nursing home. He gave residents responsibility over lives other than their own and research into this nursing home showed that residents took less prescription medicine and deaths dropped by 15 percent. Gawande thus demonstrates that creating meaningful experiences in the field of geriatric and palliative care can improve health even more effectively than focusing solely on medical interventions.
“...whatever we can offer...[is] justified only if they serve the larger aims of a person’s life.”
Through this book, I was able to slowly add new perspectives and fresh insights into my understanding of palliative care and mortality. Gawande emphasized the failings of our society when it comes to accepting death and senescence, but he also revealed how we can learn and improve. Although I had never seriously considered retirement, this novel caused me to pause and consider how I want to spend my time in old age, and what my priorities will be. Is the priority to live long or to live well? As a society, how can our institutions offer both choices to senior residents? Gawande advocates that “whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life.” In Being Mortal, the stories intertwine to form a central theme that mortality is about the struggle to live freely despite the constraints of our time here on earth and that the role of healthcare and institutions ought to be in aiding people to not only have a healthy life, but a fulfilling life - up to the very end.
- Vera Lynn
Department of Immunology
University of Toronto
1 King’s College Circle
Toronto, ON M5S 1A8
Canada
Office of the President - James and Mary Ham host women alumni at 93 Hyland (1981)
Photo Credits: University of Toronto Archives.