The goal is no longer just longevity, but the ability to thrive through the years we gain.
The first signs of aging often appear in quiet, almost unremarkable moments.
Pushing off your knees to stand up from a chair. Barely catching yourself before a stumble. Reaching for a name that used to come instantly.
At Emory University and Emory Healthcare, researchers pay close attention to these moments — not because they are dramatic, but because they are predictive. Individually, they might not mean much. But over time, they begin to tell a story about strength, balance, memory and independence. About whether the years we are gaining are years we can fully live.
For much of modern medicine, the goal was straightforward: extend life. Public health advances, vaccines, antibiotics and better treatment for chronic disease have added decades to life expectancy over the past century.
But that success has revealed a more complicated question, one that now sits at the center of aging research: What, exactly, are those added years like?
Clinicians and researchers are now focusing more on health span — the portion of a person’s life spent healthy, active, cognitively sharp and engaged. The urgency is clear. The population is aging rapidly. By 2040, the number of Americans 65 and older is expected to double. Many people will live into their 80s and beyond; some of today’s children will live well beyond 100.
But that longer life has not automatically meant healthier life. As Sharon Bergquist, founder of Emory Lifestyle Medicine and Wellness, notes, the gap between lifespan and health span in the United States is about 12.4 years — more than a decade lived in suboptimal health.
That gap is where Emory’s researchers are working. Some are studying balance, mobility and the subtle physical changes that predict decline before a crisis occurs. Others are probing how sleep, cardiovascular health, education and social connection shape the aging brain. Still others are asking what it takes to build communities in which older adults can remain safe, supported and engaged.
Taken together, their work suggests that aging well is not one thing. It is a mosaic of physical resilience, cognitive health, social connection, access to care and purpose. And it is increasingly clear that while aging is inevitable, many aspects of how people age are not.
MATTERS OF MOBILITY
For Camille Vaughan, professor of medicine and director of Emory School of Medicine’s Division of Geriatrics and Gerontology, mobility is more than a measure of physical health. It can also be an early signal of resilience, independence and future risk.
“Our philosophies of health and aging are about keeping people engaged in doing the things they want to do,” Vaughan says.
In clinic, she sees the difference every day. A patient who can still get up, move confidently and stay engaged in daily life is far more likely to remain independent — even with chronic conditions — than someone whose mobility quietly declines.
That distinction matters. Aging well does not mean aging without disease or limitation. More than half of people will develop high blood pressure as they age, Vaughan notes, simply because blood vessels stiffen over time.
The goal is not perfection. It is resilience: the capacity to adapt, function and continue doing what matters.
Movement is central to that effort. Vaughan points to a now-familiar guideline — about 30 minutes of moderate physical activity most days of the week — as a starting point. Moderate intensity, she says, means you can still talk while doing it, but not sing. But she is quick to add that cardio is only part of the story. Strength training, balance, and practical, functional movement are just as important.
“Chair stands can be a very functional exercise,” she says. “Just sit in a chair and stand up without using your arms. You have to be able to get up. There are exercises that help you with activities of daily life.”
That practical orientation is central to Emory’s work. Falls, for example, are often treated as isolated accidents, but Emory geriatric specialists tend to see them as signals of diminished strength, poor balance, medication side effects, dizziness, infection or brittle bones. A fall may be the first visible sign that something deeper is shifting.
Emory has a long history in this work. Vaughan notes that Emory researchers were involved in National Institutes of Health-funded trials three decades ago showing that tai chi can reduce falls in frail older adults.
“We used to think being a ‘weekend warrior’ had lower health benefits, but in fact the data shows that as long as you meet the 150 minutes per week, you get the bulk of the health benefits.”
— Felipe Lobelo
The biggest benefit appeared after several months, as participants built confidence, balance and control. The trial helped establish tai chi as a credible, evidence-based fall prevention strategy and demonstrated Emory’s strength in studying real-world, high-risk patients and focusing on function and independence, not just disease.
But tai chi is hardly the only option. Walking groups, exercise classes, resistance bands and programs like SilverSneakers can all help. The best exercise, Vaughan says, is often the one a person will actually do.
That message aligns with broader exercise science across Emory. Felipe Lobelo, associate professor of global health in the Rollins School of Public Health, notes that federal guidelines recommend at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week, plus strength training twice a week. How those minutes are accumulated matters less than once assumed.
“We used to think being a ‘weekend warrior’ had lower health benefits,” Lobelo says. “But in fact the data shows that as long as you meet the 150 minutes per week, you get the bulk of the health benefits.
MOVEMENT AS MEDICINE
Even so, Emory researchers emphasize a shift beyond exercise alone.
Prolonged sitting carries its own risks, independent of workouts. Scientists now understand that long stretches of inactivity impair fat metabolism, worsen glucose regulation and are linked to diabetes, cardiovascular disease, depression, dementia and some cancers. In other words, someone can work out faithfully and still be too sedentary for good health.
That is one reason Sharon Bergquist emphasizes cardiorespiratory fitness, often measured by VO2 max — the maximum amount of oxygen your body can utilize during intense exercise. It is not a term most patients hear in clinic, but she argues it deserves far more attention.
“There are literally thousands of clinical studies that show it is a better predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, cardiovascular disease and Type 2 diabetes,” she says.
Mobility research at Emory is also becoming more precise. Jane Chung, a nurse scientist in the Nell Hodgson Woodruff School of Nursing, is using GPS-based tracking, fitness watches and other digital tools to study how people move through their environments and how those patterns may predict cognitive change.
Rather than relying only on expensive scans or blood tests, her team is exploring whether everyday measures — gait speed, how often people leave home, sleep patterns, room transitions — might serve as “digital biomarkers” of risk.
The appeal is obvious: affordable, scalable tools that might detect trouble early, before a fall, hospitalization or major cognitive decline. In that sense, physical resilience is not simply about muscles and joints. It is about preserving the freedom to keep participating in life.
THE AGING BRAIN
If physical decline is the most visible marker of aging, cognitive change may be the one people fear most. James Lah, the Alice and Roy Richards Chair in Neurology at Emory School of Medicine, spends much of his time helping patients distinguish between what is normal and what is not.
Some changes, he says, are part of typical aging. Processing speed slows. Reaction times lengthen. Learning something new may take a bit more effort than it once did. But other forms of cognition — semantic knowledge, experience, judgment, wisdom — remain stable or even deepen over time.
“It’s not all downhill,” Lah says. “The respect and deference to elders based on what they have accumulated in terms of knowledge and wisdom is entirely appropriate.”
Nevertheless, the brain does change with age, just like the rest of the body.
“If I can slow [Alzheimer’s] down enough so that you never live to see the inside of memory care or skilled nursing, that’s a big win.”
— James Lah
“I often use the analogy of our skin,” says Allan Levey, Robert W. Woodruff Professor of Neurology at Emory School of Medicine. “As we age, we get wrinkles, sunspots, changes in pigmentation. Physical changes are also happening in our brain. If we look at almost anyone’s brain, we will be able to see a host of different pathologies under a microscope — the pathology of Alzheimer’s disease, of Parkinson’s disease, of vascular disease.”
Much of the anxiety around aging centers on dementia, particularly Alzheimer’s disease. It accounts for about two-thirds of late-life dementia, but many brains also show vascular injury or other pathologies alongside it. The biology is messy, overlapping and still not fully understood.
What is increasingly clear, though, is that brain aging is shaped by far more than just genetics. The 2024 Lancet Commission estimated that roughly 45% of dementia risk may be potentially modifiable.
MORE THAN MEMORY
The biggest impacts on cognition vary across the life course. Education is one of the strongest influences early in life. In midlife, hearing loss looms large, followed by hypertension, cholesterol, diabetes and depression. In later life, social isolation becomes especially important.
The connection between cardiovascular health and brain health is another recurring theme. Poorly controlled blood pressure and other vascular risks can lead to small-vessel injury in the brain, visible on MRI even in people who have never had a major stroke. Those changes can impair cognition on their own and also interact with Alzheimer’s pathology in damaging ways.
“Things that are good for your heart are also, generally speaking, very good for your brain as well,” Lah says.
Sleep belongs on that list too. Poor sleep affects thinking in the short term, but it may also influence long-term risk. New evidence suggests that the brain clears amyloid — one of Alzheimer’s hallmark proteins — most efficiently during certain stages of sleep. Disrupted sleep may interfere with that process, while also undermining memory consolidation and emotional regulation.
Lah notes that Emory Healthcare is among a select group of centers nationwide delivering recently approved infusion therapies for very early-stage Alzheimer’s — treatments that require highly specialized teams, advanced imaging and close patient monitoring.
The drugs do not stop or reverse disease, but they can slow progression in carefully selected patients. That can matter enormously.
“If I can slow it down enough so that you never live to see the inside of memory care or skilled nursing, that’s a big win,” he says.
At the same time, Emory researchers are trying to move the field upstream — toward prediction and prevention.
The Healthy Brain Study, which is an offshoot of the Healthy Aging Study, has enrolled more than 2,500 cognitively normal adults ages 50 to 75. Participants return every two years for memory testing, imaging, blood collection and, in many cases, spinal taps. Over time, the study aims to identify biomarkers of who is at risk for developing Alzheimer’s and other brain diseases, as well as who is likely to be resilient.
“Two brains can have the same pathologies present, but one person developed Alzheimer’s and one didn’t,” says Levey. “This study could help us identify what factors are protective, which might then help us work toward better treatments and perhaps prevention.”
SOCIAL IMPACTS
The science of aging can be measured in biomarkers and brain scans. But it can also be read in bus routes, sidewalks, school quality, caregiver stress and social support.
That is where Regina Shih, professor of epidemiology in the Rollins School of Public Health, spends much of her time. Her research examines how where you live, education, income and access to services shape aging trajectories — and why some groups face steeper risks than others.
“Early life education gives you one of the biggest bangs for your buck in terms of reducing your risk for dementia.”
— Regina Shih
In dementia research, she notes, lower socioeconomic status, racial inequities and rural residence are all associated with higher rates of cognitive impairment. In some of her work, rural older adults had higher dementia prevalence than those in urban areas. The gap has narrowed over time, but not because the problem solved itself. Education appears to be a major reason.
“Early life education gives you one of the biggest bangs for your buck in terms of reducing your risk for dementia,” Shih says.
More and better education is associated with cognitively stimulating jobs, healthier behaviors and better management of risk factors later in life. That is why Shih now studies not just years of schooling but educational quality: teacher-student ratios, STEM exposure and access to financial aid. These are not usually framed as aging policy. Yet they may shape cognitive health decades later.
Her work also extends into the everyday systems that make aging in place possible — or impossible. Through partnerships with Area Agencies on Aging and the national organization USAging, Shih is helping service providers build research capacity so they can document outcomes and make stronger cases for funding.
The need is immense. Meals on Wheels, respite care, transportation, home care, fall-prevention classes and caregiver support can keep older people in their homes and out of hospitals or nursing homes. But these services are chronically underfunded.
SYSTEMS OF SUPPORT
The strain shows up most clearly in caregiving. Unpaid family care in the United States was recently valued by AARP at roughly $1 trillion a year. That staggering figure reflects how much the long-term-care system depends on labor that is largely invisible and uncompensated.
“Our public health and healthcare systems rely heavily on family caregivers to help older adults age in place,” Shih says.
And family, of course, does not always mean spouse or adult child. Friends, neighbors, church members and volunteers are increasingly part of the picture. So are grassroots efforts like the Village to Village Network, in which local organizations help members with rides, social outings, health education and practical support. Shih has seen firsthand how such efforts can reduce isolation, one of the clearest threats to dementia in later life.
Camille Vaughan makes the same point from the clinical side. The social engagement she urges patients toward is not “screen time.” It is conversation, reciprocity, listening and responding. It is the mental and emotional work of being with other people.
Technology, paradoxically, may sometimes help. Chung’s work with smart speakers and motion sensors explores how digital tools can identify loneliness or help people manage chronic conditions. She is also acutely aware of the digital divide. Many lower-income older adults lack reliable internet, devices or confidence with technology. Teaching someone how to set medication reminders or troubleshoot a misbehaving speaker may sound modest, but Chung sees it as part of a broader mission: making sure innovation reaches the people most likely to be left behind.
Her research asks whether speech patterns, home activity and sensor data might help flag loneliness or cognitive risk early. It is not a replacement for human connection. It is an effort to notice vulnerability sooner — and respond.
Access to dementia care is another major front. Through Georgia Memory Net, Emory and its partners have helped create a statewide network of memory assessment clinics so patients can receive evaluations close to home rather than traveling to Atlanta. Each patient also meets with a care coordinator who addresses daily living challenges, caregiver burden and referrals to community resources. As new treatments work best in the earliest stages of disease, that kind of access becomes increasingly important.
Step back, and a consistent pattern emerges. Aging well is not simply a matter of personal responsibility. It depends in part on whether neighborhoods are walkable, whether hearing aids are affordable, whether public health departments have resources, whether caregivers have support, whether a person can get to a memory clinic, whether a library or coffee shop or pickleball court is close enough to reach.
In that sense, Emory’s aging research is not just about adding years. It is about redesigning the conditions that make those years livable.
FINDING PURPOSE
Physical and cognitive health are central to aging well. But Bergquist argues that something less measurable belongs in the conversation too: a sense of purpose.
For Bergquist, healthy aging is not just about adding years or even avoiding disease. It is also about what fills those years — whether they feel meaningful, joyful and connected to something larger than routine.
“What people remember at the end, ultimately, are memories,” she says. “You can have a very long life and not create memories, or you can have a short life that’s packed with moments and impact.”
That idea is beginning to find support in research.
Bergquist points to studies suggesting that purpose in life may buffer the effects of stress and support healthier aging at a biological level. In Emory research tied to the Healthy Brain Study, purpose in life emerged as one of the strongest predictors of cognitive resilience, outperforming some more familiar risk factors.
Her point is that healthy aging may be broader than physical and cognitive health alone. It may also depend on whether people continue to feel engaged, useful and connected to what matters most.
For all the data, the science of aging may rest on a simple cultural correction: growing older is not a failure. It is, as Vaughan puts it, “a gift.”
A gift measured not in years alone, but in moments — the ability to rise from a chair without thinking, to steady yourself after a misstep, to recall a name, to stay part of the world around you.
At Emory, the work of aging research is ultimately about protecting those moments. Because in the end, aging well is not just about how long we live, but whether we can keep living our lives — fully, independently and on our own terms — and how our social support systems and communities can help make that possible.
Illustration by Laura Coyle. Designed by Peta Westmaas