对话 | 多出12年带病人生！我们如何从“活得更久”走向“活得更好” | Bilingual

（来源：药明康德）

转自：药明康德

编者按：在过去的一个世纪里，人类平均寿命实现了显著提升，整体延长了整整四十年。然而这一成就也带来了前所未有的严峻挑战：我们的“健康寿命”（healthspan）未能实现同步增长。近期的一份报告揭示了一个严峻的现实，仅以美国为例，其人口的一生中平均12.4年处于健康不良状态。寿命长度与生命质量之间的鸿沟，正向我们的医疗体系、经济结构乃至整体社会提出了亟待解决的问题。为深入理解这些挑战，并探寻构建更美好老年生活所需的创新，我们与米尔肯研究所（Milken Institute）老龄化未来中心的执行董事Diane Ty女士进行了一次对话。

Diane Ty女士一直活跃在老龄化领域的前沿，正积极推动长寿议题讨论焦点的转变：从单纯追求延长寿命，转向全面提升健康寿命期的生活质量。她围绕健康、财务稳定与人生目标三大支柱，系统性开展工作。在米尔肯研究所，她主导致力于改善痴呆症护理的联盟及多个跨领域项目，推动政策、实践与体系的变革。此外，作为乔治城大学Business for Impact中心的高级顾问，她在健康与财务安全领域亦拥有深厚的咨询经验。

感谢您接受我们的访谈。您的工作聚焦于“老龄化的未来”，这一概念涵盖了广泛的社会变迁。能否请您详细阐释这个概念的具体内涵及其重要性？

Diane Ty：如今更准确的表述应该是“老龄化与长寿的未来”，因为我们正面临人口老龄化问题，这是影响社会各个层面的全球性大趋势。过去百年间人类寿命延长了四十年，这一成就或许堪称人类历史上最伟大的进步。然而我们的现有体系，尤其是医疗保健与养老保障系统，尚未为这些新增的寿命年限做好充分准备。

对我而言，"老龄化与长寿的未来"是一个多维度的概念。首先，我们需要思考如何确保人们在延长的生命岁月中能够保持健康体魄与经济稳定，同时构建重视人生各阶段价值的社会机制，使年长者能持续创造价值、维系社会联结。这首先关乎身体健康。衰老是慢性病的主要风险因素，因此老龄化未来的核心在于发展预防性医疗与精准医疗。其关键目标是延长“健康寿命”（即健康生活的年限），而不仅仅是延长“生存年限”。同时，这也关乎“财务长寿”，确保个人拥有足以支撑漫长人生的储蓄与福利保障。更重要的是，它还关乎我们在年老时的生活目标和社会联结。所有这些维度，共同构成了“老龄化未来”的完整图景。

图片来源：123RF

您在近期指出，数据显示美国人的平均寿命超出健康寿命十年以上。为缩小这一差距，个人可以采取哪些切实可行的措施？医疗体系又需要提供怎样的政策支持？

Diane Ty：在美国，人们平均有12.4年的时间处于健康不佳的状态，相比之下全球平均值仅为9.4年，两者存在明显差距。尽管这一问题没有简单的解决方案，但科学证据已表明，通过调整生活方式可有效预防和延缓慢性疾病的发生与进展。其中，首要因素是坚持锻炼，人类自30岁后每十年会流失3%至8%的肌肉量，因此坚持抗阻训练、平衡训练与柔韧性锻炼对预防跌倒尤为重要。美国健康指南建议人们每周进行150至300分钟中高强度锻炼，但目前仅有30%的成年人能达到这一标准。此外，遵循以植物为主、营养丰富的膳食模式（如地中海饮食）同样是延长健康寿命的关键要素。

社会联结同样至关重要。研究显示，社交隔离与孤独感带来的健康风险，相当于每日吸十五支香烟。而拥有明确的生活目标则能产生积极影响，有助于降低认知衰退与血管疾病的风险。此外，优质睡眠同样不可或缺，大量研究证实它能显著改善我们的健康状况。

图片来源：123RF

在政策层面，现有医疗体系的设计初衷并非用于投入预防性护理。有人如此评价，我们仍处于一个“治疗疾病”的体系，而不是“管理健康”的体系。我认为这种状况正在转变。越来越多的人认识到，我们必须加大对早期筛查、疾病预防的投入，并建立与之匹配的价值导向型付费模式。同时，我们深知家庭照护者的重要性，特别是在照护神经退行性疾病患者时。我们需要通过提供让照护者得到适当休息的服务、专业培训和税收优惠等措施，支持这些承受着身心双重压力的照护者。从国家层面、联邦政府层面到医疗体系内部，都存在诸多政策创新的机遇。

大多数老年人都希望在家中安度晚年。您认为科技能为年长者及其照护者提供哪些支持？这些技术的应用过程又主要面临着哪些障碍？

Diane Ty：我们正目睹科技领域涌现诸多令人振奋的进展。互联照护技术及其配套设备服务生态系统的成熟，正在为选择居家养老的老年人重塑生活体验。例如，我们可以借助技术和人工智能来预防跌倒。我们可以监测步态与活动模式的细微变化，及时识别功能衰退征兆，从而在源头上防范跌倒风险。对照护者而言，数字化护理协调系统、共享应用程序与门户平台，以及搭载可穿戴设备的远程监测系统，都能实现生命体征的持续追踪。

图片来源：123RF

然而令人困惑的是，现有技术多为孤立解决方案，尚未形成统筹全局的生态系统，各类设备间缺乏协同运作。实现各设备间的互联互通已成为刚性需求，而隐私保护问题同样不容忽视。我们曾针对照护双方（如成年子女与老人）开展研究，发现双方需求存在显著冲突：家庭照护者往往聚焦安全与保障，而老人则更关注马斯洛需求理论（Maslow’s hierarchy）中更高层次的自我实现与独立人格需求。常见的情形是，成年子女购置的科技设备最终被束之高阁，因为在年长者眼中，这些设备无异于对其隐私的侵犯。因此，深刻理解这种复杂的需求差异至关重要。

您刚才提到家庭照护者承受着巨大压力。能否请您详细说明这一危机的严重程度，以及它需要哪些政策支持？

Diane Ty：照护者群体往往处于被忽视的状态，许多人甚至不自视为照护者，认为这只是为人子女或配偶的本分。但如今这种情况正在改变。美国退休人员协会（AARP）的最新数据显示：全美现有6300万家庭照护者，其中70%同时从事着有偿工作。当前美国职场中，照料老年人的劳动者数量已然超过照顾学龄前儿童的劳动者。

图片来源：123RF

我们正面临严峻的照护危机：专业照护人员严重短缺，等候照护服务的人数却居高不下。政策改革刻不容缓。在我们的调研中，照护者持续向我们传达两大核心诉求：职业保障与带薪家庭照护假。我们需要联邦政府层面的政策支持。职场层面也需要积极行动。我们亟需推行灵活的工作安排：远程办公、混合办公、弹性工时或岗位共享等。但对雇主而言，最具成本效益的举措是营造“照护包容文化”，让管理者公开分享自身照护经历，以消除对在职照护者的污名化，并使照护行为成为一种正常现象。

在您看来，在痴呆症的早期诊断方面，我们目前面临的主要障碍有哪些？又应采取哪些应对策略来克服这些障碍？

Diane Ty：首先我想纠正衰老必然导致认知衰退这一常见误区，事实并非如此。我希望认知评估能像血压检测一样成为常规体检项目。我们应当从中年就开始建立认知基线，以便追踪随时间推移的认知变化。科学研究表明，大脑的病理改变在症状出现前二十年就已悄然发生。早期诊断能够识别出可干预或可逆的致病因素，例如睡眠呼吸暂停、听力受损或维生素缺乏。若人们能理解这一点，他们对大脑健康检查的抗拒或许就会减少。

感谢您的深刻见解！面对我们所讨论的诸多挑战与机遇，您认为现行退休体系应如何适应这些额外延长的生命年限？

Diane Ty：我们所掌握的一些数据令人警醒：50岁及以上的美国人中，有五分之一完全没有退休储蓄。值得欣慰的是，退休计划提供的退休收入解决方案与相关产品正在发展，这些创新方案能提供稳定的现金流。另一方面，个人需要提升自己的“长寿认知素养”。研究表明，当人们对自身预期寿命形成准确认知时，其财务规划与储蓄行为往往更为合理。

我期待构建一个以预防为先，更加整合的医疗体系。这个体系将重点开展对心血管、代谢及认知健康的风险筛查和预防性干预，并从个体中年期起就将这些服务纳入常规检查项目。在此体系中，居家照护将成为主流模式，依托远程监测与人工智能驱动的临床支持系统；同时，家庭照护者也将被正式认定为医疗团队的重要组成部分，并获得培训支持、休息服务及税收优惠等多方面保障。

Closing the Gap: A Conversation with Diane Ty, Managing Director, Future of Aging, Milken Institute

Editor’s Note: One of the greatest triumphs of the last century is the dramatic increase in human lifespan, with humanity gaining an extra 40 years of life in the past 100 years. However, this success has revealed a profound new challenge: our "healthspan" has not kept pace. A recent report highlighted a stark reality: in the U.S., people are living an average of 12.4 years in poor health, the largest such gap in the world. This disparity between how long we live and how long we live well presents urgent questions for our healthcare systems, economies, and societies. To understand these challenges and explore the innovations needed to create a better future of aging, we spoke with Diane Ty. As the Managing Director of the Milken Institute Future of Aging, Diane is at the forefront of shaping a new narrative around longevity. Her work focuses on reframing the conversation from simply extending life to enhancing the quality of those extra years through a focus on health, financial stability, and purpose.

Diane, thank you for joining us today. Your work focuses on the "future of aging," a term that encompasses massive societal shifts. Can you break down what this concept means and why it's such a critical issue?

Diane Ty: It's more the future of aging and longevity now, because we're looking at population aging. It's a global megatrend in terms of impacting every aspect of society. We've gained an extra 40 years of life in the past 100 years, and this increase in life expectancy is perhaps the greatest achievement in human history. However, our systems, especially our healthcare and retirement security systems, are not well prepared for these added years of longevity.

To me, “future of aging” means a few things. First, how can we ensure that our longer lives are lived in good health, with economic stability, and with institutions and communities that value every stage of life so older adults can continue to contribute and connect? It's about health. Aging is the predominant risk factor for chronic disease, so the future of aging is about preemptive care, preventive care, and precision medicine. The focus is on healthspan, the years lived in good health, as opposed to just lifespan. It's also about financial longevity and ensuring we have the savings and benefits to sustain us. And importantly, it's about purpose and social connection as we age. All of these domains make up the future of aging.

Source：123RF

You've noted in a recent report that Americans live over a decade longer than they remain healthy. What actionable steps can individuals take to close this gap, and what policies are needed from the healthcare system to support them?

Diane Ty: In the U.S., people are on average living 12.4 years in poorer health. This gap between healthspan and lifespan is the largest in the world; the global average is 9.4 years. While there's no easy answer, we have abundant scientific evidence for how we can prevent and delaychronic diseases through lifestyle behaviors. First, exercise is critical; we lose about three to eight percent of our muscle mass every decade after age 30, so resistance training, balance, and flexibility are very important to prevent falls. U.S. health guidelines recommend 150 to 300 minutes per week of moderate to vigorous exercise, yet only 30 percent of adults are meeting that guideline. Additionally, a nutrient-dense, more plant-focused diet, like the Mediterranean diet, is key.

Social connection is also crucial, as social isolation and loneliness increase health risk to an equivalent of smoking 15 cigarettes a day. Living with purpose has a positive impact and is linked to lowering the risk of cognitive decline and vascular disease. Finally, high-quality sleep is essential; there is so much research showing how it can improve our health.

Source：123RF

On the policy side, our healthcare system isn't designed to invest in preventive care; you hear the saying that we're a "sick care" system versus a "well care" system. I think that is changing. There's a growing recognition that we need to invest in earlier detection, prevention, and in the value-based payment models that can support that. We also know how important the family caregiver is, particularly when someone has a neurodegenerative disease. We need to support that family caregiver who is undergoing their own mental and physical stress with caregiver respite, training, and tax incentives. There are many policy opportunities at the national and federal level, as well as within the healthcare system.

Most older adults want to age at home. What role can technology play in supporting them and their caregivers, and what are the primary barriers to adoption?

Diane Ty: We're seeing very exciting developments in technology enabling connected care and a whole ecosystem of devices and services that can shape a new experience for older adults who want to age at home. For example, you can use technology and AI to focus on fall prevention. We can monitor changes in movement or gait to look for signs of deterioration, which can help prevent a fall from happening in the first place. For caregivers, digital care coordination, shared apps and portals, and remote monitoring with wearables can track vital signs.

Source：123RF

However, the confusing part is that a lot of these are single-point solutions; we are not yet looking holistically at the ecosystem and how these devices work together. Interoperability is a definite need. There's also a definite concern for privacy. I did some research where we looked at care dyads, such as an adult child and the older adult. They have colliding needs. The family caregiver is often focused on safety and security. But the older adult may be higher up on Maslow's hierarchy, focused on self-actualization and independence. We hear stories of tech devices that the adult child purchases ending up in a drawer because the older adult sees it as invading their privacy. Understanding that complex set of needs is critical.

You've spoken about the immense burden on family caregivers. Can you elaborate on the scale of this crisis and what policies are needed to address it?

Diane Ty: Caregivers have often been invisible, not even self-identifying because they are just being a son, a daughter, or a spouse. But it's becoming more visible now. AARP (American Association of Retired Persons) recently came out with new statistics: there are now 63 million family caregivers, with 70% also working in a paid role. There are more U.S. workers caring for an older adult today than for a preschool-aged child.

Source：123RF

We have a real crisis on our hands, with a shortage of direct care workers and too many people on waiting lists for care. We need policy change. In our research, caregivers consistently tell us they want job protection and paid family leave. The U.S. is the only OECD country without a national guarantee of paid family care leave. We need something at the federal level. The workplace also needs to come forward. We need flexible work arrangements: remote, hybrid, flexible hours, or job sharing. But one thing that is not costly for an employer is creating a care-aware culture, where leaders openly share their own caregiving stories to reduce stigma and normalize it.

Regarding dementia, what are the barriers to early detection and how can we overcome them?

Diane Ty:First, I want to address the misperception that cognitive decline is an inevitable part of aging; it is not. I would like to see cognitive assessment become part of routine care, like checking your blood pressure. We should start in midlife to have a baseline so you can track change over time. We know that changes to the brain are happening up to 20 years before any symptoms manifest. Early detection can identify addressable or reversible causes, such as sleep apnea, hearing loss, or a vitamin deficiency. If people understood that, they might be less fearful about getting their brain health checked.

Thank you for the insights! With all the challenges and opportunities discussed, how should our retirement system adapt to these extra years of life?

Diane Ty: We hear some pretty sobering statistics; one in five Americans age 50 and over have no retirement savings. One of the bright spots is the development of in-plan retirement income solutions and products offered within retirement plans that provide a steady income stream. Another thing individuals can do is improve their "longevity literacy". Studies show that when you have a realistic sense of your lifespan, you do a much better job of planning and saving.

My wish is for a more integrated, prevention-first healthcare system. This system would focus on risk detection and preemptive care for cardiovascular, metabolic, and cognitive health, making it standard and routine beginning in midlife. In this system, home-based care would be mainstream, supported by remote monitoring and AI-driven clinical support systems, and family caregivers would be recognized as an essential part of the care team, supported with training, respite care, and tax benefits.

参考资料：

[1] Diane Ty. Retrieved October 30, 2025, from https://milkeninstitute.org/experts/diane-ty