The science of ageing is a captivating field. Researchers are exploring the roles of senescent cells, their signalling pathways, and drugs like metformin and rapamycin in extending lifespans—at least in animals. Yet, when it comes to humans, clinical evidence is scarce. Why? The challenges are significant.
The challenges to overcoming this are three-fold:
- Logistical Hurdles: Humans live long lives, so any study assessing an anti-ageing intervention requires decades of follow-up—an impractical timeline.
- Practical Complications: Throughout our long lifespans, countless factors—lifestyle choices, genetics, and pure chance—can influence the results. To minimize these confounding variables, studies would need an enormous number of participants to improve the “signal-to-noise ratio.”
- Definitional Ambiguity: While mortality is straightforward to measure, decrepitude is not. How do we quantify “ageing,” especially when it’s a highly variable process? Not all 60-year-olds experience the same symptoms or even appear the same age. Moreover, there’s no universally accepted biomarker that accurately correlates with age.
Given these challenges, large-scale anti-ageing studies are not only costly but also difficult to monetize—patents, for instance, would likely expire before meaningful results emerge. Consequently, we don’t expect any “anti-ageing” medicine approvals in the near future.
Ageing: A Healthcare Megatrend
However, one does not need to play the direct science of ageing to benefit from this area. There is the more obvious demographic reality that age brings decrepitude long before death. The management of an increasingly elderly population burdened with chronic (i.e. incurable and irreversible lifelong morbidity) is a huge megatrend that forms the fundamental basis of how healthcare investors – including ourselves – look at the sector.
The older we get, the more complex our needs become and the inter-section of all these things results in huge amounts of additional spending. This will manifest in growing needs for interventional surgery in the cardiovascular and musculoskeletal fields, alongside the increased use of early detection diagnostics for more severe disease associated with age (cancer, dementia etc.). These interventions should be brought to bear as early as possible.
It is a sad reality today that most of us will incur the majority of our lifelong healthcare costs in the final months to years of life, will die in hospital, and will experience a significant deterioration in quality of life toward the end of our time. With this being the reality, we think that the current goals of medical intervention should not be so much to increase lifespan, but to increase “healthspan”. By doing so, such investment can close the gap between life years led in good health versus total life years. This gap is currently moving the wrong way due in no small part to the global obesity crisis.
Improving Quality of Life in Later Years
What we do know about quality of life in later years is that a good diet, regular exercise, strong community links and a sense of purpose are strongly correlated with good outcomes. These are things that many of us can influence through life choices and the others are things that wider society could do much to help improve.
In the meantime, the ageing population presents a massive investment opportunity in healthcare provision. Healthcare should be a key focus in any long-term portfolio, but investors must also consider the broader societal consequences. Rising per capita healthcare expenses may seem like an endless investment opportunity, but they come with a rising dependency ratio. Government-funded healthcare costs will soar, increasing the tax burden, while private care in later years will become more expensive. This may compel us all to start saving earlier for future healthcare expenses.
Tackling the Affordability Crisis
The impending affordability crisis will force the healthcare industry to address its historically high levels of waste and inefficiency. Currently, about 25% of healthcare spending is wasted. One in four doctor-patient interactions are deemed medically unnecessary, and highly skilled frontline staff spend about a third of their time on administrative tasks.
Fortunately, there is immense potential to improve cost-effectiveness and efficiency. In a global industry that spends around $10 trillion annually, the money-saving opportunities are vast. While improving productivity may not sound as thrilling as groundbreaking scientific discoveries, companies delivering these solutions are just as vital to the future of geriatric healthcare as new products and devices.
To meet the demands of an ageing population, the healthcare industry must undergo profound changes. Current approaches are neither scalable nor affordable. Investing in products, technologies, and services that improve patient outcomes, lower costs, and help caregivers make better decisions is crucial. This includes everything from medical devices to software applications for disease management, wearable technology, and middle and back-office systems that streamline patient management. These investments are essential to making healthcare more efficient in the face of an ageing global population.
The author is Paul Major, Portfolio Manager at London-based Bellevue Healthcare Trust
