Key advances

Pitts noted that advances in the treatment of diabetes include devices for glycemic self-monitoring and insulin delivery systems.


“Continuous glucose monitoring (CGM) devices were introduced in 1999 and are now the standard of care for people with type 1 diabetes and people with type 2 diabetes on meal-time insulin,” Pitts said. “Real-time CGM can tell both the patient and the healthcare provider when glucose is in the normal range, and when they are experiencing hyper- or hypoglycemia.”


This data, along with changes in lifestyle, eating habits, and medications can help people maintain improved control over their glycemic range, he added.

Pitts calls the decline in mortality from CHD and stroke the “medical success story of the past 4 decades.”

“This decline can be attributed almost equally to risk factor control and major pharmacological and technological advances in both the acute and long-term treatment of CHD and stroke,” he said. “These advances have given Americans an additional decade of longevity,” he said.

Pitts lists such advances in treating heart disease as:

  • better statins, beta-blockers, and blood thinners
  • MRI and CT scans that offer precise diagnostic imaging
  • effective education on healthier diets and anti-smoking efforts
  • advances in medical devices and innovative surgical procedures
  • portable heart pumps (the first patient received one in 1991)
  • minimally invasive valve surgery, known as transcatheter aortic valve replacement (developed in 2002)


“And 3-D printing technology can create precision models of the heart and other anatomical structures to help surgeons better prepare for congenital heart surgery,” Pitts said. “For patients with faulty heart valves, alternatives to chest-opening surgery are evolving.”


When it comes to chronic obstructive pulmonary disease (COPD) and other respiratory diseases, Pitts said that prevention is key.

“Education on the dangers of smoking is more important than ever, especially now as a younger generation has embraced vaping,” he said.

There’s no cure for COPD. The goals of treatment are to prevent further lung damage and manage symptoms.

According to Pitts, recent advances in COPD treatment include:

  • maintenance medications to help control symptoms and flareups
  • quick-relief medications to treat worsening symptoms
  • better long-acting muscarinic antagonists (LAMA)
  • the first nebulized LAMA for those who struggle to use inhalers

Cognitive impairment is the exception

One exception to the trend was cognitive impairment. It’s the only long-term condition where prevalence decreased.

However, the research revealed a decline in years spent free from disability.

Evelyn Duffy is an adult gerontological nurse practitioner and Florence Cellar professor of gerontological nursing at the Frances Payne Bolton School of Nursing in Cleveland.

Duffy told Healthline that the newer model of thinking around Alzheimer’s disease is that it’s a failure of the body to mobilize an immune response when amyloid plaques develop in the brain.


“Looking back to the early ’80s, we didn’t know what process was causing dementia,” Duffy said. “We did know that people with dementia most often die of infectious disease.”


She explained that as memory declines, people tend to become less mobile and do less for themselves.

“As memory and mobility decline, muscle mass declines,” Duffy said. “Muscles that help you swallow are affected, so it’s hard to swallow pills. Food stays in the throat or gets aspirated into the lungs. Muscles that help you cough are affected, so people end up getting pneumonia.

All of that was once thought to be due to cognitive decline.

“We now understand that it’s a failure of immune defenses,” Duffy said. “All older adults have a decline in immune response, which we’ve seen with COVID-19. In dementia, it’s more accelerated.”

According to Duffy, people with dementia are more likely to develop other chronic conditions like:

  • rheumatoid arthritis and other autoimmune diseases
  • thyroid problems
  • pressure ulcers and breakdown of skin due to prolonged inactivity
  • urinary problems
  • infection

The COVID-19 effect

The study took place before the emergence of COVID-19.

The Centers for Disease Control and Prevention reports a drop in life expectancy due to the disease.

“A disproportionate number of deaths occurred among Black and Latino populations,” Pitts said. “These populations are more likely to be affected by chronic conditions like diabetes and heart disease.”

“They are also more likely to live in multigenerational homes, work in jobs with greater risk of transmission, and have lower vaccination rates,” he added. “Due to their co-morbidities, many died even if they were vaccinated due to renal failure, diabetes, or lung disease. These racial and ethnic groups also disproportionately experience obesity, which increases [the] risk of death by a factor of three.”