對話 | 多出12年帶病人生！我們如何從“活得更久”走向“活得更好” | Bilingual

編者按：在過去的一個世紀里，人類平均壽命實現了顯著提升，整體延長了整整四十年。然而這一成就也帶來了前所未有的嚴峻挑戰(zhàn)：我們的“健康壽命”（healthspan）未能實現同步增長。近期的一份報告揭示了一個嚴峻的現實，僅以美國為例，其人口的一生中平均12.4年處于健康不良狀態(tài)。壽命長度與生命質量之間的鴻溝，正向我們的醫(yī)療體系、經濟結構乃至整體社會提出了亟待解決的問題。為深入理解這些挑戰(zhàn)，并探尋構建更美好老年生活所需的創(chuàng)新，我們與米爾肯研究所（Milken Institute）老齡化未來中心的執(zhí)行董事Diane Ty女士進行了一次對話。

Diane Ty女士一直活躍在老齡化領域的前沿，正積極推動長壽議題討論焦點的轉變：從單純追求延長壽命，轉向全面提升健康壽命期的生活質量。她圍繞健康、財務穩(wěn)定與人生目標三大支柱，系統(tǒng)性開展工作。在米爾肯研究所，她主導致力于改善癡呆癥護理的聯盟及多個跨領域項目，推動政策、實踐與體系的變革。此外，作為喬治城大學Business for Impact中心的高級顧問，她在健康與財務安全領域亦擁有深厚的咨詢經驗。

感謝您接受我們的訪談。您的工作聚焦于“老齡化的未來”，這一概念涵蓋了廣泛的社會變遷。能否請您詳細闡釋這個概念的具體內涵及其重要性？

Diane Ty：如今更準確的表述應該是“老齡化與長壽的未來”，因為我們正面臨人口老齡化問題，這是影響社會各個層面的全球性大趨勢。過去百年間人類壽命延長了四十年，這一成就或許堪稱人類歷史上最偉大的進步。然而我們的現有體系，尤其是醫(yī)療保健與養(yǎng)老保障系統(tǒng)，尚未為這些新增的壽命年限做好充分準備。

對我而言，"老齡化與長壽的未來"是一個多維度的概念。首先，我們需要思考如何確保人們在延長的生命歲月中能夠保持健康體魄與經濟穩(wěn)定，同時構建重視人生各階段價值的社會機制，使年長者能持續(xù)創(chuàng)造價值、維系社會聯結。這首先關乎身體健康。衰老是慢性病的主要風險因素，因此老齡化未來的核心在于發(fā)展預防性醫(yī)療與精準醫(yī)療。其關鍵目標是延長“健康壽命”（即健康生活的年限），而不僅僅是延長“生存年限”。同時，這也關乎“財務長壽”，確保個人擁有足以支撐漫長人生的儲蓄與福利保障。更重要的是，它還關乎我們在年老時的生活目標和社會聯結。所有這些維度，共同構成了“老齡化未來”的完整圖景。

圖片來源：123RF

您在近期指出，數據顯示美國人的平均壽命超出健康壽命十年以上。為縮小這一差距，個人可以采取哪些切實可行的措施？醫(yī)療體系又需要提供怎樣的政策支持？

Diane Ty：在美國，人們平均有12.4年的時間處于健康不佳的狀態(tài)，相比之下全球平均值僅為9.4年，兩者存在明顯差距。盡管這一問題沒有簡單的解決方案，但科學證據已表明，通過調整生活方式可有效預防和延緩慢性疾病的發(fā)生與進展。其中，首要因素是堅持鍛煉，人類自30歲后每十年會流失3%至8%的肌肉量，因此堅持抗阻訓練、平衡訓練與柔韌性鍛煉對預防跌倒尤為重要。美國健康指南建議人們每周進行150至300分鐘中高強度鍛煉，但目前僅有30%的成年人能達到這一標準。此外，遵循以植物為主、營養(yǎng)豐富的膳食模式（如地中海飲食）同樣是延長健康壽命的關鍵要素。

社會聯結同樣至關重要。研究顯示，社交隔離與孤獨感帶來的健康風險，相當于每日吸十五支香煙。而擁有明確的生活目標則能產生積極影響，有助于降低認知衰退與血管疾病的風險。此外，優(yōu)質睡眠同樣不可或缺，大量研究證實它能顯著改善我們的健康狀況。

圖片來源：123RF

在政策層面，現有醫(yī)療體系的設計初衷并非用于投入預防性護理。有人如此評價，我們仍處于一個“治療疾病”的體系，而不是“管理健康”的體系。我認為這種狀況正在轉變。越來越多的人認識到，我們必須加大對早期篩查、疾病預防的投入，并建立與之匹配的價值導向型付費模式。同時，我們深知家庭照護者的重要性，特別是在照護神經退行性疾病患者時。我們需要通過提供讓照護者得到適當休息的服務、專業(yè)培訓和稅收優(yōu)惠等措施，支持這些承受著身心雙重壓力的照護者。從國家層面、聯邦政府層面到醫(yī)療體系內部，都存在諸多政策創(chuàng)新的機遇。

大多數老年人都希望在家中安度晚年。您認為科技能為年長者及其照護者提供哪些支持？這些技術的應用過程又主要面臨著哪些障礙？

Diane Ty：我們正目睹科技領域涌現諸多令人振奮的進展。互聯照護技術及其配套設備服務生態(tài)系統(tǒng)的成熟，正在為選擇居家養(yǎng)老的老年人重塑生活體驗。例如，我們可以借助技術和人工智能來預防跌倒。我們可以監(jiān)測步態(tài)與活動模式的細微變化，及時識別功能衰退征兆，從而在源頭上防范跌倒風險。對照護者而言，數字化護理協調系統(tǒng)、共享應用程序與門戶平臺，以及搭載可穿戴設備的遠程監(jiān)測系統(tǒng)，都能實現生命體征的持續(xù)追蹤。

圖片來源：123RF

然而令人困惑的是，現有技術多為孤立解決方案，尚未形成統(tǒng)籌全局的生態(tài)系統(tǒng)，各類設備間缺乏協同運作。實現各設備間的互聯互通已成為剛性需求，而隱私保護問題同樣不容忽視。我們曾針對照護雙方（如成年子女與老人）開展研究，發(fā)現雙方需求存在顯著沖突：家庭照護者往往聚焦安全與保障，而老人則更關注馬斯洛需求理論（Maslow’s hierarchy）中更高層次的自我實現與獨立人格需求。常見的情形是，成年子女購置的科技設備最終被束之高閣，因為在年長者眼中，這些設備無異于對其隱私的侵犯。因此，深刻理解這種復雜的需求差異至關重要。

您剛才提到家庭照護者承受著巨大壓力。能否請您詳細說明這一危機的嚴重程度，以及它需要哪些政策支持？

Diane Ty：照護者群體往往處于被忽視的狀態(tài)，許多人甚至不自視為照護者，認為這只是為人子女或配偶的本分。但如今這種情況正在改變。美國退休人員協會（AARP）的最新數據顯示：全美現有6300萬家庭照護者，其中70%同時從事著有償工作。當前美國職場中，照料老年人的勞動者數量已然超過照顧學齡前兒童的勞動者。

圖片來源：123RF

我們正面臨嚴峻的照護危機：專業(yè)照護人員嚴重短缺，等候照護服務的人數卻居高不下。政策改革刻不容緩。在我們的調研中，照護者持續(xù)向我們傳達兩大核心訴求：職業(yè)保障與帶薪家庭照護假。我們需要聯邦政府層面的政策支持。職場層面也需要積極行動。我們亟需推行靈活的工作安排：遠程辦公、混合辦公、彈性工時或崗位共享等。但對雇主而言，最具成本效益的舉措是營造“照護包容文化”，讓管理者公開分享自身照護經歷，以消除對在職照護者的污名化，并使照護行為成為一種正常現象。

在您看來，在癡呆癥的早期診斷方面，我們目前面臨的主要障礙有哪些？又應采取哪些應對策略來克服這些障礙？

Diane Ty：首先我想糾正衰老必然導致認知衰退這一常見誤區(qū)，事實并非如此。我希望認知評估能像血壓檢測一樣成為常規(guī)體檢項目。我們應當從中年就開始建立認知基線，以便追蹤隨時間推移的認知變化。科學研究表明，大腦的病理改變在癥狀出現前二十年就已悄然發(fā)生。早期診斷能夠識別出可干預或可逆的致病因素，例如睡眠呼吸暫停、聽力受損或維生素缺乏。若人們能理解這一點，他們對大腦健康檢查的抗拒或許就會減少。

感謝您的深刻見解！面對我們所討論的諸多挑戰(zhàn)與機遇，您認為現行退休體系應如何適應這些額外延長的生命年限？

Diane Ty：我們所掌握的一些數據令人警醒：50歲及以上的美國人中，有五分之一完全沒有退休儲蓄。值得欣慰的是，退休計劃提供的退休收入解決方案與相關產品正在發(fā)展，這些創(chuàng)新方案能提供穩(wěn)定的現金流。另一方面，個人需要提升自己的“長壽認知素養(yǎng)”。研究表明，當人們對自身預期壽命形成準確認知時，其財務規(guī)劃與儲蓄行為往往更為合理。

我期待構建一個以預防為先，更加整合的醫(yī)療體系。這個體系將重點開展對心血管、代謝及認知健康的風險篩查和預防性干預，并從個體中年期起就將這些服務納入常規(guī)檢查項目。在此體系中，居家照護將成為主流模式，依托遠程監(jiān)測與人工智能驅動的臨床支持系統(tǒng)；同時，家庭照護者也將被正式認定為醫(yī)療團隊的重要組成部分，并獲得培訓支持、休息服務及稅收優(yōu)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 thatwe 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.

參考資料：

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

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