Dynamic Multi-System Resilience in Human Aging/TimBuchman

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Notes by user Tim Buchman (Emory Univ./SFI) for Dynamic Multi-System Resilience in Human Aging

Post-meeting Reflection

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Presentation highlights

Open questions that came up

How your perspective changed

Impact on your own work

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An excellent first day. We heard theory-based perspectives and came directly upon the challenges of human subjects research. The theory based perspectives from Dervis Vural, Peter Hoffmann, and Alfons Hoekstra illustrated the (relative) simplicity of models that effectively abstract and recapitulate several well-recognized characteristics of human aging and frailty. Yet human-derived data are messy, do not lend themselves easily to hypothesis testing because they are so often observational and incomplete, and are confounded by the outbred nature of humans, their varying allostatic loads, and the variety of acute-on-chronic illnesses that bring them to research studies and/or clinical care.

The most interesting part of the second day, perhaps, was the presentation on resiliency among the indigenous peoples of NM. It became quite clear that the ability to (re)generate networks and interactions was foundational to regenerating the population. A reasonable inference , and mirroring Dervis Vural's presentation on Day 1, is that the capacity to reconstruct networks is foundational to resilience. It is unclear whether it is the ability to reconstruct some evolutionarily specified or developmental network is required, or rather a more general capacity. But "fixing a failed node" is unlikely to work unless that failed node is the foundational "network spawner".

The need for a marker that reliably informs clinicians that the capacity to recover from perturbation is now (and forever) exhausted is apparent. The problem around end of life is acknowledging that it is indeed end-of-life, that the physiological derangement exceeds reparative capacity, with or without the stabilization that clinicians can provide. As technical medicine gets better at dealing with minutiae, such markers of inevitable collapse become even more important. As a reminder, 27% of the US Medicare budget is routinely spent in the last year of life, with a substantial uptick in the last month as part of the "rescue phantasy" to use Freud's term. "slowing" and delayed correction of spontaneous or engineered perurbations is a start, but seems by itself insufficient as a basis for clinical decision making.

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Reference Materials

Title	Author name	Source name	Year	Citation count From Scopus. Refreshed every 5 days.	Page views
The community of the self	Timothy G. Buchman	Nature	2002	157	14
The community of the self2	Timothy G. Buchman	Nature	2002	157	14
The community of the self3	Timothy G. Buchman	Nature	2002	157	8
Uncoupling of Biological Oscillators				0	2
Community of the Self				0	0