Jarachikitsa and Gerosciences for healthy ageing – A public health perspective

Health of older people has rightly drawn policy attention as the world undergoes a demographic transition. The United Nations Assembly declared 2021–30 as the Decade of Healthy Ageing [1]. The World Health Organization's baseline report for this global collaborative shows at least 14% of people (about 142 million) above 60 years are unable to meet all their basic needs for activities of daily living. The goal of the Decade is optimizing functional ability. The currently accepted definition of healthy ageing is “the process of developing and maintaining functional ability that enables wellbeing in older age”. Notably, the Indian knowledge systems mention much of longevity and the importance of functionality. The Vedic literature states ‘Jivem sharadah shatam Pashyem sharadah shatam’. It not only proclaims “let us witness the supreme spirit for 100 years, let us live for one hundred years and preserve our vital senses and organs for one hundred years” but further states that all senses should be functional and an individual should never loose self-respect and self-esteem until the last breath. With such parallels about wellbeing of the elderly between ancient and modern knowledge, it may be worthwhile to revisit the ancient sciences using a contemporary lens as the world aspires to evolve actions for healthy ageing.

Although not a disease by itself, ageing process makes people vulnerable to many diseases. Age and ageing process are the strongest risk factors for several diseases such as heart disease, stroke, cancer, neurodegeneration, osteoporosis. In the current times with increasing longevity, more interest is now in increase in health span i.e., period of life free of major chronic clinical diseases and disability. Hence factors that delay or prevent the broad spectrum of diseases associated with mortality and disability are important from a public health perspective. However currently majority of health programs address individual and acute conditions rather than a spectrum of old age conditions. Although major investments are made to develop effective geroprotectors. Currently exercise, even with modest implementation, is the only intervention with remarkable efficacy in reducing age related dysfunction, improving quality of life and life span. However, the molecular pathways that mediate this effect of exercise are yet to be identified. There is much to be explored in Gerosciences to inform strategies for healthy ageing. In this regard, traditional knowledge is attracting increasing research attention. Moreover, as conventional medicine is practiced as disease specific and organ specific, it often leads to polypharmacy, especially in the elderly as they suffer multimorbidity. This is because multimorbidity is often seen as individual disease rather than multisystem expression of advanced stage of ageing. An integrative management based on a systems biology based holistic approach is more desirable in ageing research.

The mechanisms that slow down ageing process are known to be associated with delayed onset of most major chronic diseases. Currently, the major focus in geriatrics is on slowing the fundamental biological process of ageing such as inflammation, oxidative stress, and mitochondrial dysfunction. However, recently scientists propose optimization of physiological function throughout life to achieve optimal longevity along with health span. Age associated decline in physiological function is critical target to address the challenges posed by population ageing. Strategies for primary prevention through slowing in functional decline and secondary prevention through reducing diseases and disabilities in older adults are required in public health programs.

Ayurveda is more focused on the physiological processes and hence has more to offer for primordial prevention and health promotion. Swasthavritta, a branch of Ayurveda, provides keys to health promotion considering age, nutrition, metabolic attributes and individual tolerance and sensitivity all in the context of individual and seasonal variations. The recommended measures are specific to chronobiological changes and include daily routine (dincharya), seasonal variations (ritucharya) and behaviour (Sadvritta) in order to maintain homeostasis and avoid imbalances that cause disease. These include lifestyle and dietary measures that affect the overall metabolic processes and are yet simple measures for health preservation in all ages. Ayurveda advocates ethical and moral behaviour through Sadvritta that includes compassion with all living beings, sacrifice, controlling body–mind, and speech and respecting the interests of others as minimum expectations. The concepts of Swasthavritta overlap much with the modern concepts of behavioral medicine [2]. The role of physical activity, diet, socialization for healthy ageing are now increasingly recognized. Dietary geroprotection and nutribiography (influence of individual's diet history on ageing) are emerging as new specialties. Spirituality and its role in mental health is now increasingly recognized even in the Western world.

Geriatrics, the medical discipline has led to Geroscience, an interdisciplinary field that aims to understand the relationship between aging and age-related diseases and disabilities. With the rise of Gerosciences the focus on diseases is expanding to a more holistic approach with an emphasis on the individual's physiology. This calls for a noteworthy confluence of Ayurveda and Geroscience. Interestingly, though geriatrics is relatively new in medicine, one of the eight branches of Ayurveda- Jarachikitsa deals specifically with health and diseases of the elderly. This is an important component of Rasayana, which is a specialty of Ayurveda to enhance growth, retard ageing, modulate immunity, and induce tissue regeneration. Rasayana therapy improves longevity, memory, intelligence, health, youth, complexion, voice, and motor and sensory strength through lifestyle, diet and medicines of botanical, mineral and animal origins. The Rasayana approach offers promise for discoveries in healthy ageing, rejuvenation and regeneration. Emerging fields of rejuvenation research, regenerative medicine and tissue engineering are likely to gain from Rasayana knowledge. Rasayana are known to be immunoadjuvants and have been found to be effective as vaccine adjuvants potentiating the protective effects of vaccines [3]. Notably, the distinction of Rasayana as immunomodulating agents compared to other conventional immunomodulators, is that they activate immune function without altering the other physiological mechanisms. This allows for long term use in conditions requiring constant immune activation such as in the elderly. Neurodegenerative processes in the elderly result in diseases such as Alzheimer's disease and Parkinson's disease where Rasayana specific to brain (Medhya rasayanas) are beneficial owing to their properties to retard brain aging and help regeneration of neural tissues. Anticancer activities of Rasayana are known and growing literature from clinical studies indicates their potential as chemoadjuvants. Radioprotective effects of Rasayana is another area of relevance to elderly given the prevalence of cancer and radiation therapy use. Rasayana as adjuvants in radiation therapy have been explored in a few studies and offer promise. The potential of Rasayana specific to tissues hold much promise for translational research in regenerative biology and stem cell therapy. Ayurveda lays much emphasis on dietary measures and advises personalized diet. While calorie restriction is found promising for healthy ageing it remains to be explored if the Ayurveda diet has more to offer. The therapeutic procedures (Panchkarma) in Ayurveda aimed at strengthening physiological functions to restore homeostasis offer a vast potential to Geroscientists.

The Government of India has responded to the challenge of ageing population with the launch of the Rashtriya Varishtha Jan Swathya Yojana in 2016. This scheme offers services to the elderly through Regional Geriatric Centers through network of selected medical colleges. Another initiative by Government of India was the National Programme for Healthcare of the Elderly (2010–11) initiated to build capacity of the medical and paramedical professionals as well as the care-takers within the family for providing health care to the elderly. Inclusion of the knowledge from Indian traditional medicine, or AYUSH systems, such as Ayurveda, Yoga, Siddha and Unani in these initiatives may help serve the purpose more efficiently.

Future research should step beyond merely testing Ayurveda drugs as candidates and explore deeper into the principles. For example, it is indicated that Rasayana interventions act through nutrition dynamics normalizing the digestion and metabolism, and by improved tissue perfusion of nutrients at molecular level. This logic of Rasayana action is not considered in the currently available studies. Future research involving these epistemological considerations may give deeper scientific insights into mechanisms of Rasayana actions. The promising potential of insights from Jarachikitsa to inform Gerosciences awaits to be explored for effective public health programs. Providing impetus to such transdisciplinary research. Ought to be an immediate action agenda for the decade of healthy ageing.



(Acknowledgements to Prof Bhushan Patwardhan for sharing his insights.)