why DO things happen?
- Thread starter Will Bozarth
- Start date
dreaming neon darkspot
natures' retard
...spending an eternity here,lol.I bet that's going to be what the afterlife is like-one big giant internet messageboard.
lol that would be cool.. you die, then you go somewhere for the rest of eternity that has every message board's link, and you have na assigned screen name
Part I
History of the world is replete with tales of individuals trying to stave off aging and death. King David wooed young virgins in search of youthfulness. Wealthy people go to private European medical centers for lamb cell injections. Many individuals take megadoses of vitamin E, drink Kombucha tea, use coenzyme Q10 etc., all in the hope of finding the "fountain of youth". The difficulty is to separate fact from myth.
Researchers know unequivocally that there is no elixir of youth, but are finding out that some of the biological hallmarks of age can be postponed. This can result in increased vitality in later years.
First a few facts. It would appear that the body reaches peak efficiency at the age 30 and then declines in many ways. Using age 30 as reflective of 100% performance, we see the following: (a) pumping efficiency of the heart is reduced about 20% when a person reaches 55, (b) kidney function is reduced about 25% at 55 years of age, (c) maximum breathing capacity declines about 40% by 55 and 60% by 75 years , (d) basal metabolism rate goes down about 10%.
The average life span has been significantly expanded so that theoretically it is conceivable that a person could live to 140 years, if we are able to deal with the chronic ailments associated with aging i. e. heart disease, cancer, Alzheimer's Disease, stroke etc. By eliminating these chronic ailments, lives will be healthy and productive and will only end because of unstoppable biological declines.
Pathologists report that at least thirty percent of people older than 85 years have minor traumas that their bodies would withstand at earlier ages, but now cause death. As mentioned in the above article on respiratory diseases, the immune system looses its ability to effectively deal with new minor infections resulting in death among the elderly, but not among young people. The more youthful your immune system, the more likely you are to become a centenarian, as seen in a study done at the University of Kentucky on individuals between 100 and 103 years of age.
Interestingly, cancer accounts for 30 % of the deaths among people 65 to 69, but only 12% of those over 80. Cancers seem to grow slower, the older one becomes. Heart disease deaths have declined among the 40 to 60 year old group but is increasing among the older group. This would appear to be a function of the efforts by the government to get individuals to reduce their risk of heart disease with low-fat diets, stopping smoking, watching their weight and monitoring blood pressure levels. It seemed a cost -effective method in dealing with the medical costs that were burdening our society.
Today, 80% of coronary deaths are in the over-65 group. This group will soon include a large population of our "baby-boomers" which suggests the need for greater effort to find effective ways to handle coronary attacks in the elderly. Our population now has a life expectancy at birth of 76 years. In 1900 it was 47 years. According to an article in the Wall Street Journal (Feb. 27, 1997), "If mortality rate had remained at 1900 levels throughout the 20th century, the U.S. population would be 139 million in 2000, rather than the expected 276 million The population would have grown just 72% over the 100 years, rather than the actual 240% it will have grown."
Exercise, while not prolonging life, can retard some of the functional declines that accompany aging, such as the loss of muscle mass, capacity for physical effort, flexibility, endurance, bone strength and efficiency of the heart and lungs. It can also help normalize blood pressure, blood sugar and blood cholesterol levels, as well as ward off depression. Exercise does not improve pulmonary function, but increases the amount of oxygen consumption resulting in the reduction of the workload on the heart.
Yet indications are that adolescents are smoking more, are heavier and are exercising less than their parents. It is estimated that obesity affects more than one-third of the United States population, with prevalence exceeding 40% in blacks and Hispanics. At the same time, 50% of patients are moderately malnourished on admission to a hospital.
It is fairly common to speculate as to what triggered a heart attack in the elderly. Was it any of the known risk factors (heredity, old age, high blood pressure, inactivity etc.)? Or are there other factors.
One such factor is homocysteine, an amino acid, which appears to be implicated in heart disease. Studies, which compared individuals who had heart attacks or strokes with healthy cohort group, found that high homocysteine levels distinguished the two groups. Two longitudinal studies ( a study which follows people who are healthy over a long period of time to determine what happens to them), one in Boston and the other in Norway found that men who were highest in homocysteine levels faced a threefold greater risk of having a heart attack and young women have a higher risk of stroke.
While genetics may be important, diet also plays an robust role, both as cause and a treatment. We get homocysteine from dried beans and peas, enriched whole-grain cereals, nuts, dark green, leafy vegetables and orange juice. You can also supplement your diet with the consumption of folate or folic acid. Jane E. Brody, in her "Personal Health" column ((Feb. 26,1997) states: "Dr. Robert Russell of Tufts estimated that raising folic acid intake to 400 micrograms a day could prevent at least 13,500 deaths from heart attacks each year. Currently, only about 40% of Americans consume that much."
Another fairly common disorder seen in the elderly is stroke. Yet, 28% of patients with stroke are under 65 years of age, and women account for 40% of the new cases. Blacks in the United States have a rate of mortality due to stroke roughly twice that of whites. The United States has one of the lowest mortality rates due to stroke and the rate continues to decline, most probably due to changes in life style.
According to a review article in The New England Journal Of Medicine (Nov. 23, 1995) "Hypertension is currently the most consistently powerful predictor of stroke; it is a factor in nearly 70% of strokes. Hypertension promotes stroke by aggravating atherosclerosis in the aortic arch and cervicocerebral arteries; causing arteriosclerosis and lipohylaninosis in the small-diameter, penetrating end arteries of the cerebrum; and contributing to heart disease, of which stroke is a complication." The authors go on further to report that "In elderly patients (more than 60 years of age), antihypertensive therapy has decreased the risk of stroke by a range of 25% to 47%." Again, we point out that physical activity (i.e., exercise) reduces the risk factors for cardiovascular disease. We would suggest that everyone needs to increase their levels of physical activity. Surveys indicated that among people 18 to 74 years of age, only 24% reported moderate physical activity and only 14% reported vigorous activity.
Other interesting research going on in the field of Geriatrics, is the role of caloric intake and aging. The results of animal testing indicates that eating fewer calories in a well balanced, nutrient dense diet does wonders for the health and longevity of rodents. (See: Scientific American, January 1996, "Caloric Restriction and Aging" by Richard Weindruch, 46-52.) Weindruch concludes his article with "It may take another 10 or 20 years before scientists have a firm idea of whether caloric restriction can be as beneficial for humans as it clearly is for rats, mice and a variety of other creatures." There are many caveats in his article including lack of knowledge of the effect of low calorie intake on an individuals ability to withstand stress and its effect on fertility in females.
Part II
With normal aging, there is a decrease in bone mass, muscle strength and lean body mass and an increase in fat body mass. Physiological and anatomical changes related to aging include increased susceptibility to heat and cold exposure, decreased immune responses to infections, increased falls, and toxicity to medications. These factors place older adults at risk of worsening health and premature death.
A National Health Interview Survey revealed that 39% of persons over 65 years of age suffered some limitation of activity due to chronic conditions and that 11% were unable to carry out some major activity. Those over 65 also experienced approximately 50% more disability days due to acute conditions than did younger persons. There would appear to be a need to develop standards for a health risk appraisal, which includes not only an assessment of current health status but also an evaluation of risk factors for future health outcomes. (See: Breslow, L. (1997) Development of HRA for the Elderly. Am J of Health Promotion Vol. 11, #5, May.)
In general, women experience compromised life quality while men experience compromised longevity as they age. The latest figures indicate that the current life expectancies for males is 71.4 years, while for females it is 78.3 years. Males have higher mortality from all leading causes of death. Women tend to have more illnesses and lower self-rated health.
As people age, their sense of well being seems tied in with their relations with peers and in particular with friendship (See: Jerome, D (1993) Intimate relationships. In Aging in Society-An Introduction to Social Gerontology, 2nd edition (J. Bond, P. Coleman & S peace Eds.) Sage, London)
Gender differences in friendship are particularly marked and, over the years, research has increasingly pointed to the value of a special relationship or confidant in adjusting to the stresses and strains of later life. For women especially, this is also a life course issue in that the presence of a confidant or close friend has been found to be important in terms of social support as well as in the maintenance of psychological well-being and mental health. Moreover, rather than fulfilling this need for a confidant within the marriage relationship, women tend to look to other women or an adult child for this kind of support. Men, by contrast, name their wives as their main source of emotional support and the only person that they talk with about personal problems and difficulties.
Women's friendship are said to be person-oriented, emotionally richer than men's, and characterized by emotional support, intimacy, self disclosure and mutual assistance. This is conveyed by talk: conversation being one of the main activities of female friendship from early childhood onwards. Men's friendships on the other hand, tend to be activity oriented and based on shared experiences.
Studies showed that among those older people with children, proximity tended to increase with age, with widowhood resulting is a move nearer to children. In a study by Clare Wenger, over half of the parents saw a child at least once a week and this rose to three-quarters in the case of parents over 80. Only 2% of the parents never saw their children. (See: Wenger, C. (1992) Help in Old Age-Facing up to Change. Institute of Human Aging, Liverpool University Press, Liverpool.)
For those older people unable to carry out domestic tasks unaided, relatives were the usual source of help. Research has also confirmed that women are more likely than men to take the main responsibility, as well as to devote long hours to the tasks associated with informal care (See: Allen, N.H.p. & Burns, A.B. (1995) The non-cognitive features of dementia. Rev Clin Gerontol, 5(1), 57-75.
Early retirement has meant an increase in the amount of time couples can choose to spend with each other, ahead of some of the health changes associated with late old age. There has been a decline of joint residence between elderly parents and their adult children, a change, which gathered momentum from the 1960's onward.
Gender differentiation in household work may diminish after retirement, with greater participation by husbands in traditionally "female" tasks such as cleaning and shopping. Such participation is defined as "helping" wives and therefore doesn't change the basic division of household chores. Husbands tend to encroach on wives personal time and space and the husband's presence begins to create different forms of domestic work for their wives.
Retirement can bring out the negative aspects of a marriage, especially for women. Women tend to benefit less from their husband's retirement than do retiring husbands.
In America, it is estimated by 2005 over half of those reaching retirement age will be divorced at least once. Remarriage is more frequent at all stages of the life span. Currently one in every three marriages involves remarriage of one partner. The remarriage rate is higher for men than for women of all ages, leading to an increased likelihood of women being alone in future years. Widowhood among women in late life is a high probability event and this is particularly the case for women aged 75 years or over. For example, 65% of women in this age group are widowed. This reflects both women's greater life expectancy and their tendency to marry men older than themselves. Nearly one-third of widows suffers from depression six months following bereavement. Widowhood contributes to lower morale and declines in physical health in the short term, but stability in social functioning.
Eight of the ten leading causes of death among persons 65 years and older were related to chronic diseases, including diseases of heart, malignant neoplasm, cerebrovascular disease, arteriosclerosis, diabetes, emphysema and nephritis. Eighty percent of persons 65+ have at least one chronic disease. In one US national study, 49% of non-institutionalized people aged 60 or older had 2 or 3 of the nine chronic conditions surveyed, 23% had 3 or more and 8% had 4 or more. (See: Guralnik et al. Aging in the 80's: The prevalence of comorbidity and association with disability. Advanced Data from Vital and Health Statistics, # 170, National Center for Health Statistics, Public Health Service, Hyattsville, MD. 1989.)
Sleep disturbances increase with age and a variety of factors have been implicated in contributing to this phenomenon. Surveys indicate a correlation between poor sleep and female gender, anxiety, self-rated health, depressive symptoms, use of medication, nocturia, chronic pain and somatic disease. Another factor that disturbs sleep is dementia, the incidence of which is high in nursing homes.
Nursing home residents show anywhere from a 45% to 75% incidence of poor sleep. This a high percentage is probably due to a combination of factors, including age related changes; medical, psychiatric and primary sleep disorders; medications, circadian rhythm disturbances and nursing home environment.
Not uncommonly, the sleep-wake cycle of older residents does not coincide with the institutions schedule and therefore, residents are sometimes put in bed before they are ready to go to sleep.
Pain is the most common complaint among nursing home residents with the most common cause being musculoskeletal disorders. Pain is often inadequately treated in nursing homes. By providing better analgesia, sleep disturbances might be curtailed.
Nursing homes should try more individualized night-time care practices, such as aides doing hourly rounds and providing care only if the patients are awake, at high risk for pressure sores or still asleep at the third checking. Need to stress the importance of resident sleep to the nurses and aides, emphasizing they should try to be less noisy and use quieter carts. For the agitated patient, they may try "white noise" machines as well as audiotapes of mountain streams or gentle ocean sounds, which have been shown in some studies to calm people down.
Previously, we had written of the problem of decrease in bone mass with aging. Recently, studies have indicated a role for recombinant human growth hormone (rhGH) in increasing the lean body mass in growth-deficient adults. Studies further indicate that low doses of recombinant growth hormone "are able to modify bone composition by increasing lean body mass, increasing lipogenesis, promoting lipolysis in opposition to the action of insulin on adiopocytes and enhancing the anabolic effects mediated by IGF-1 on protein synthesis in muscle mass." By increasing the muscle strength, it produces an improvement in muscle mass and function. (See: Clemmons, D.R., Underwood, L.E.: Role of insulin-like growth factors and growth hormone in reversing catabolic states. Hormone Research 38 (Suppl. 2): 37-40, 1992.) It should be noted that this study also indicated that the hormone does not improve bone density, but does effect bone metabolism, influencing bone formation and resorption.
Possible side effects of this hormone include impaired glucose tolerance and reduced insulin sensitivity and increase in triglyceride levels, all factors in increasing morbidity rates in the aged.
Part III
From 1960 to 1990 the total US population grew by 30%, whereas the number of persons sixty-five years of age or older increased 89% and the number 85 years of age increased 232 %. (Bureau of Census. Current population report. 65 plus in America. Washington: US Government Printing Office; 1993).
In this series of articles, we have been describing the definable physiological parameters, which differentiate younger from older adults beyond actual age itself. In general, it appears that the process of aging involves a decline in the efficiency of various cells and tissues and systems. The real question is then what precipitates this decline in efficiency and can it be avoided. Memory impairment probably represents the most obvious change occurring both in the so-called physiological aging and in pathological aging.
One of the assumptions in biology is that normal cells can go through only a fixed number of divisions before they die, a process called senescence. The assumption leads to the conclusion that this accounts for the aging process. Harry Rubin, Professor of Molecular Biology at University of California, Berkeley wrote a review article in Mechanism of Aging and Development 1997; 98:1-35. The article entitled Cell aging in vivo and in vitro, presents evidence that cells "accumulate damage over a lifetime [that] results in gradual loss of differentiated function and growth rate". He rejects the notion of an intrinsic limitation of the number of cell divisions. It is the damage to cells over a lifetime that stimulates the effects of aging, which induces a gradual loss of differentiated function of the cells and growth rate. This stress (e.g. biochemical damage) on the cells reduces its capacity to multiply. It is not related to changes in hormonal states, blood flow or other system effects of aging. This is an important distinction for researchers to make in understanding what is aging. Reduce "the stress" and you prolong life.
Dr. Rubin believes that cells enter an altered stage of growth, due to stress, which renders them susceptible to cancer and other types of intrinsic events( caused or initiated by process that originates within the body) that can lead to death. Rubin states:"there is ample evidence for a decrease in stability of the genome with age which would help to account for the exponential increase in cancer with age. This does not rule out an additional need in many cases for multiple mutations to produce a fully autonomous cancer. More likely, both factors, and perhaps others, contribute to the age dependence of cancer incidence." What happens is that cells loss their capacity to control gene expression. It is this slowing down or loss that manifests itself as the aging process.
There are attempts by the body to deal with this process as result of the stabilizing feature of multcellularity in organs where metabolic cooperation among cells occurs. "Multicellularity also provides the opportunity for continuous selection of the least damage cells." (Rubin). The object then is to reduce the stress on cells to prevent the start of altered growth stages, manifested as aging.
It would seem that there is something in the architecture of the gene that relates in some way to longevity. Scientists have found that every chromosome has tails (telomeres) at its ends that get shorter as a cell divides. The telemere length is hypothesized to give some indication of how many divisions the cell has already undergone and how many remain before it becomes senescent. Is this the result of "stress" or a natural process? What would happen if we were able to stop this process? Continued cellular growth is seen in cancer where cells seem to be immortal. Is this the result of an abnormal gene product, telomere non-shrinkage, or other factors? Maybe if we understand the biochemistry of aging, we will have some of the answers, producing longer and healthier lives. The next part of this series will look at the healthy older person and what distinguishes that person from the rest of the population.
Part IV
As we reviewed the first three parts of this series, it became clear that there are a number of items that we did not make explicit about the aging process. While these statements are known by all, they have vast significance for the process of aging.
First and foremost, is the objective fact that biological aging affects everybody, evidencing itself overtly and covertly at different ages and in different organs and systems depending on a whole series of cascading effects. Secondly, it is a deleterious process, involving the functioning of cells and therefore organs and finally the organism itself. Thirdly, this process is subtle in most cases, usually manifesting itself when the changes become extreme, or not until the system as a whole is stressed. Fourthly, it is not known if the process of aging is a disease or a natural process of the organism i.e. is there a built in general death factor or if all disease is conquered will we achieve immortality.
As we age, the amount of stress required to cause a breakdown in the health of the organism falls. (This axiom is related to a definition of aging cited by Alex Comfort: Aging is characterized by failure to maintain homeostasis under conditions of physical stress, a failure which is associated with a decrease in viability and an increase in vulnerability of the individual.) See part III of this series for discussion of stress factors..
We also know that age-related changes that do occur have a limiting effect on a number of bodily functions. Changes in the lens of the eye lead to presbyopia; changes in the cochlea of the ear lead to presbyacusis; a reduction in the accuracy of maintaining posture increases the amount of sway in the standing positions etc.
The big research dilemma revolves around distinguishing between changes, which are associated with normal aging and those which are due to external or internal pathological effects. Osteoporosis is a good example of this problem. As every reader must know, this disorder predisposes an individual to bone fractures. It is generally regarded as an age-related disease, particularly severe in post- menopausal women. However, there are also a number of pathological conditions that predispose one to this disorder or are associated with the development of osteoporosis such as prolonged immobility, poor nutrition, and excessive alcohol intake or corticosteroid treatment.
Another prominent example of etiology is impairment in body temperature control. It is partly assumed to be due to the aging process but it may be made worse by cerebrovascular disease or the dementing process such as Alzheimers Disease.
Postural hypotension is another of those problems that have both age-related and pathological sources. What appears to happen in most of the age-related vulnerabilities is that physiological systems decline with age resulting in a shift in the accuracy of the body to control the chemical and cellular environment and thus leaving individuals more prone to diseases of aging. (Again see Part III of this series where we discuss the cumulative effects of stress on cellular division and the process of senescence.)
In fact, if one were to look at the presenting medical problems of the elderly, six symptoms would stand out: mental confusion, respiratory problems, incontinence, postural instability and falls, immobility and social breakdown. While they are problems of the elderly, no one has definitively shown robust evidence that they are age-related. It is mainly beyond the age of 75 and more particularly 85 years that frailty and the dependence associated with chronic illness becomes apparent. Yet, generally, these changes were going on for many years, at levels below which we are able to detect and associate conclusively with the age-related deterioration process. Conversations with medical personnel suggest that healthy elderly people quite often have laboratory test results which are slightly abnormal, but are not deemed significant. While there are many chance factors that may account for these "abnormalities", they may be precursors of cell or system age-related changes leading to expression of disease at a much later date. The sooner we identify signs of a disorder, the more likely treatment will be effective.
This leads us to the "health strategy" we suggest for all people: A medical checkup should include a full blood work-up, a biochemical profile, an estimate of serum electrolytes, a urine analysis for protein and sugar, and a baseline cardiogram and chest radiograph. By establishing a measurement baseline, future check-ups will alert you to changes that may be soft signs of deteriorating or degenerative processes. At the same time, the physician/patient relationship should be a collaborative one in which the doctor gathers and disseminates information and the patient is active in applying the healing, using knowledge of their needs in synergistic fashion with the information received. In this way the patient is empowered in the most important aspect of life, the patient's health.
A look at life expectancy charts indicates an increase of life expectancy throughout the twentieth century. This is associated with the external improvements in health including the improvement in hygiene and nutrition and the conquest of certain infectious diseases by the process of clean water, vaccination, antibiotics and other forms of medical treatment. While more can be done with explicit factors of illness, the balance is now fully in the corner of implicit factors including but not limited to a healthy life style.
This should not be construed as shifting the onus of responsibility to the individual. Achievement of health always is a collaborative process involving the individual, treating health professionals, industry and the government. The latter needs to play an important role in monitoring the environment, encouraging research and providing care to individuals in need of service.
Developing a unifying theory of aging is an important goal of the geriatric field. As one reviews the literature on theory of aging, one becomes aware of almost 100 theories which could be broken down to two main categories which tend to be mutually exclusive, but both probably contain parts of a meta-theory.
The first category relates to programming theories and involves genetic coding, incorporating the concept that progressive expression of the appropriate genes throughout life leads to the changes of aging and ultimately to death.
The second category, error theories, contend that environmental influences on the organism lead to errors in gene transcription and protein synthesis and that the steady accumulation of these errors are the cause of aging and death. Over a period of time, the organism is exposed to a series of stresses that lead to malfunctioning similar to what occurs in machinery over time i.e. structural stress.
Future parts of this series will discuss theories of aging in detail to give our readers knowledge, the most powerful tool one could have in their armentarium.
Please e-mail us any questions that you may have, and we will respond as quickly as we can. If you have no objection, we may post your question and our answer in our question and answer section of this site
History of the world is replete with tales of individuals trying to stave off aging and death. King David wooed young virgins in search of youthfulness. Wealthy people go to private European medical centers for lamb cell injections. Many individuals take megadoses of vitamin E, drink Kombucha tea, use coenzyme Q10 etc., all in the hope of finding the "fountain of youth". The difficulty is to separate fact from myth.
Researchers know unequivocally that there is no elixir of youth, but are finding out that some of the biological hallmarks of age can be postponed. This can result in increased vitality in later years.
First a few facts. It would appear that the body reaches peak efficiency at the age 30 and then declines in many ways. Using age 30 as reflective of 100% performance, we see the following: (a) pumping efficiency of the heart is reduced about 20% when a person reaches 55, (b) kidney function is reduced about 25% at 55 years of age, (c) maximum breathing capacity declines about 40% by 55 and 60% by 75 years , (d) basal metabolism rate goes down about 10%.
The average life span has been significantly expanded so that theoretically it is conceivable that a person could live to 140 years, if we are able to deal with the chronic ailments associated with aging i. e. heart disease, cancer, Alzheimer's Disease, stroke etc. By eliminating these chronic ailments, lives will be healthy and productive and will only end because of unstoppable biological declines.
Pathologists report that at least thirty percent of people older than 85 years have minor traumas that their bodies would withstand at earlier ages, but now cause death. As mentioned in the above article on respiratory diseases, the immune system looses its ability to effectively deal with new minor infections resulting in death among the elderly, but not among young people. The more youthful your immune system, the more likely you are to become a centenarian, as seen in a study done at the University of Kentucky on individuals between 100 and 103 years of age.
Interestingly, cancer accounts for 30 % of the deaths among people 65 to 69, but only 12% of those over 80. Cancers seem to grow slower, the older one becomes. Heart disease deaths have declined among the 40 to 60 year old group but is increasing among the older group. This would appear to be a function of the efforts by the government to get individuals to reduce their risk of heart disease with low-fat diets, stopping smoking, watching their weight and monitoring blood pressure levels. It seemed a cost -effective method in dealing with the medical costs that were burdening our society.
Today, 80% of coronary deaths are in the over-65 group. This group will soon include a large population of our "baby-boomers" which suggests the need for greater effort to find effective ways to handle coronary attacks in the elderly. Our population now has a life expectancy at birth of 76 years. In 1900 it was 47 years. According to an article in the Wall Street Journal (Feb. 27, 1997), "If mortality rate had remained at 1900 levels throughout the 20th century, the U.S. population would be 139 million in 2000, rather than the expected 276 million The population would have grown just 72% over the 100 years, rather than the actual 240% it will have grown."
Exercise, while not prolonging life, can retard some of the functional declines that accompany aging, such as the loss of muscle mass, capacity for physical effort, flexibility, endurance, bone strength and efficiency of the heart and lungs. It can also help normalize blood pressure, blood sugar and blood cholesterol levels, as well as ward off depression. Exercise does not improve pulmonary function, but increases the amount of oxygen consumption resulting in the reduction of the workload on the heart.
Yet indications are that adolescents are smoking more, are heavier and are exercising less than their parents. It is estimated that obesity affects more than one-third of the United States population, with prevalence exceeding 40% in blacks and Hispanics. At the same time, 50% of patients are moderately malnourished on admission to a hospital.
It is fairly common to speculate as to what triggered a heart attack in the elderly. Was it any of the known risk factors (heredity, old age, high blood pressure, inactivity etc.)? Or are there other factors.
One such factor is homocysteine, an amino acid, which appears to be implicated in heart disease. Studies, which compared individuals who had heart attacks or strokes with healthy cohort group, found that high homocysteine levels distinguished the two groups. Two longitudinal studies ( a study which follows people who are healthy over a long period of time to determine what happens to them), one in Boston and the other in Norway found that men who were highest in homocysteine levels faced a threefold greater risk of having a heart attack and young women have a higher risk of stroke.
While genetics may be important, diet also plays an robust role, both as cause and a treatment. We get homocysteine from dried beans and peas, enriched whole-grain cereals, nuts, dark green, leafy vegetables and orange juice. You can also supplement your diet with the consumption of folate or folic acid. Jane E. Brody, in her "Personal Health" column ((Feb. 26,1997) states: "Dr. Robert Russell of Tufts estimated that raising folic acid intake to 400 micrograms a day could prevent at least 13,500 deaths from heart attacks each year. Currently, only about 40% of Americans consume that much."
Another fairly common disorder seen in the elderly is stroke. Yet, 28% of patients with stroke are under 65 years of age, and women account for 40% of the new cases. Blacks in the United States have a rate of mortality due to stroke roughly twice that of whites. The United States has one of the lowest mortality rates due to stroke and the rate continues to decline, most probably due to changes in life style.
According to a review article in The New England Journal Of Medicine (Nov. 23, 1995) "Hypertension is currently the most consistently powerful predictor of stroke; it is a factor in nearly 70% of strokes. Hypertension promotes stroke by aggravating atherosclerosis in the aortic arch and cervicocerebral arteries; causing arteriosclerosis and lipohylaninosis in the small-diameter, penetrating end arteries of the cerebrum; and contributing to heart disease, of which stroke is a complication." The authors go on further to report that "In elderly patients (more than 60 years of age), antihypertensive therapy has decreased the risk of stroke by a range of 25% to 47%." Again, we point out that physical activity (i.e., exercise) reduces the risk factors for cardiovascular disease. We would suggest that everyone needs to increase their levels of physical activity. Surveys indicated that among people 18 to 74 years of age, only 24% reported moderate physical activity and only 14% reported vigorous activity.
Other interesting research going on in the field of Geriatrics, is the role of caloric intake and aging. The results of animal testing indicates that eating fewer calories in a well balanced, nutrient dense diet does wonders for the health and longevity of rodents. (See: Scientific American, January 1996, "Caloric Restriction and Aging" by Richard Weindruch, 46-52.) Weindruch concludes his article with "It may take another 10 or 20 years before scientists have a firm idea of whether caloric restriction can be as beneficial for humans as it clearly is for rats, mice and a variety of other creatures." There are many caveats in his article including lack of knowledge of the effect of low calorie intake on an individuals ability to withstand stress and its effect on fertility in females.
Part II
With normal aging, there is a decrease in bone mass, muscle strength and lean body mass and an increase in fat body mass. Physiological and anatomical changes related to aging include increased susceptibility to heat and cold exposure, decreased immune responses to infections, increased falls, and toxicity to medications. These factors place older adults at risk of worsening health and premature death.
A National Health Interview Survey revealed that 39% of persons over 65 years of age suffered some limitation of activity due to chronic conditions and that 11% were unable to carry out some major activity. Those over 65 also experienced approximately 50% more disability days due to acute conditions than did younger persons. There would appear to be a need to develop standards for a health risk appraisal, which includes not only an assessment of current health status but also an evaluation of risk factors for future health outcomes. (See: Breslow, L. (1997) Development of HRA for the Elderly. Am J of Health Promotion Vol. 11, #5, May.)
In general, women experience compromised life quality while men experience compromised longevity as they age. The latest figures indicate that the current life expectancies for males is 71.4 years, while for females it is 78.3 years. Males have higher mortality from all leading causes of death. Women tend to have more illnesses and lower self-rated health.
As people age, their sense of well being seems tied in with their relations with peers and in particular with friendship (See: Jerome, D (1993) Intimate relationships. In Aging in Society-An Introduction to Social Gerontology, 2nd edition (J. Bond, P. Coleman & S peace Eds.) Sage, London)
Gender differences in friendship are particularly marked and, over the years, research has increasingly pointed to the value of a special relationship or confidant in adjusting to the stresses and strains of later life. For women especially, this is also a life course issue in that the presence of a confidant or close friend has been found to be important in terms of social support as well as in the maintenance of psychological well-being and mental health. Moreover, rather than fulfilling this need for a confidant within the marriage relationship, women tend to look to other women or an adult child for this kind of support. Men, by contrast, name their wives as their main source of emotional support and the only person that they talk with about personal problems and difficulties.
Women's friendship are said to be person-oriented, emotionally richer than men's, and characterized by emotional support, intimacy, self disclosure and mutual assistance. This is conveyed by talk: conversation being one of the main activities of female friendship from early childhood onwards. Men's friendships on the other hand, tend to be activity oriented and based on shared experiences.
Studies showed that among those older people with children, proximity tended to increase with age, with widowhood resulting is a move nearer to children. In a study by Clare Wenger, over half of the parents saw a child at least once a week and this rose to three-quarters in the case of parents over 80. Only 2% of the parents never saw their children. (See: Wenger, C. (1992) Help in Old Age-Facing up to Change. Institute of Human Aging, Liverpool University Press, Liverpool.)
For those older people unable to carry out domestic tasks unaided, relatives were the usual source of help. Research has also confirmed that women are more likely than men to take the main responsibility, as well as to devote long hours to the tasks associated with informal care (See: Allen, N.H.p. & Burns, A.B. (1995) The non-cognitive features of dementia. Rev Clin Gerontol, 5(1), 57-75.
Early retirement has meant an increase in the amount of time couples can choose to spend with each other, ahead of some of the health changes associated with late old age. There has been a decline of joint residence between elderly parents and their adult children, a change, which gathered momentum from the 1960's onward.
Gender differentiation in household work may diminish after retirement, with greater participation by husbands in traditionally "female" tasks such as cleaning and shopping. Such participation is defined as "helping" wives and therefore doesn't change the basic division of household chores. Husbands tend to encroach on wives personal time and space and the husband's presence begins to create different forms of domestic work for their wives.
Retirement can bring out the negative aspects of a marriage, especially for women. Women tend to benefit less from their husband's retirement than do retiring husbands.
In America, it is estimated by 2005 over half of those reaching retirement age will be divorced at least once. Remarriage is more frequent at all stages of the life span. Currently one in every three marriages involves remarriage of one partner. The remarriage rate is higher for men than for women of all ages, leading to an increased likelihood of women being alone in future years. Widowhood among women in late life is a high probability event and this is particularly the case for women aged 75 years or over. For example, 65% of women in this age group are widowed. This reflects both women's greater life expectancy and their tendency to marry men older than themselves. Nearly one-third of widows suffers from depression six months following bereavement. Widowhood contributes to lower morale and declines in physical health in the short term, but stability in social functioning.
Eight of the ten leading causes of death among persons 65 years and older were related to chronic diseases, including diseases of heart, malignant neoplasm, cerebrovascular disease, arteriosclerosis, diabetes, emphysema and nephritis. Eighty percent of persons 65+ have at least one chronic disease. In one US national study, 49% of non-institutionalized people aged 60 or older had 2 or 3 of the nine chronic conditions surveyed, 23% had 3 or more and 8% had 4 or more. (See: Guralnik et al. Aging in the 80's: The prevalence of comorbidity and association with disability. Advanced Data from Vital and Health Statistics, # 170, National Center for Health Statistics, Public Health Service, Hyattsville, MD. 1989.)
Sleep disturbances increase with age and a variety of factors have been implicated in contributing to this phenomenon. Surveys indicate a correlation between poor sleep and female gender, anxiety, self-rated health, depressive symptoms, use of medication, nocturia, chronic pain and somatic disease. Another factor that disturbs sleep is dementia, the incidence of which is high in nursing homes.
Nursing home residents show anywhere from a 45% to 75% incidence of poor sleep. This a high percentage is probably due to a combination of factors, including age related changes; medical, psychiatric and primary sleep disorders; medications, circadian rhythm disturbances and nursing home environment.
Not uncommonly, the sleep-wake cycle of older residents does not coincide with the institutions schedule and therefore, residents are sometimes put in bed before they are ready to go to sleep.
Pain is the most common complaint among nursing home residents with the most common cause being musculoskeletal disorders. Pain is often inadequately treated in nursing homes. By providing better analgesia, sleep disturbances might be curtailed.
Nursing homes should try more individualized night-time care practices, such as aides doing hourly rounds and providing care only if the patients are awake, at high risk for pressure sores or still asleep at the third checking. Need to stress the importance of resident sleep to the nurses and aides, emphasizing they should try to be less noisy and use quieter carts. For the agitated patient, they may try "white noise" machines as well as audiotapes of mountain streams or gentle ocean sounds, which have been shown in some studies to calm people down.
Previously, we had written of the problem of decrease in bone mass with aging. Recently, studies have indicated a role for recombinant human growth hormone (rhGH) in increasing the lean body mass in growth-deficient adults. Studies further indicate that low doses of recombinant growth hormone "are able to modify bone composition by increasing lean body mass, increasing lipogenesis, promoting lipolysis in opposition to the action of insulin on adiopocytes and enhancing the anabolic effects mediated by IGF-1 on protein synthesis in muscle mass." By increasing the muscle strength, it produces an improvement in muscle mass and function. (See: Clemmons, D.R., Underwood, L.E.: Role of insulin-like growth factors and growth hormone in reversing catabolic states. Hormone Research 38 (Suppl. 2): 37-40, 1992.) It should be noted that this study also indicated that the hormone does not improve bone density, but does effect bone metabolism, influencing bone formation and resorption.
Possible side effects of this hormone include impaired glucose tolerance and reduced insulin sensitivity and increase in triglyceride levels, all factors in increasing morbidity rates in the aged.
Part III
From 1960 to 1990 the total US population grew by 30%, whereas the number of persons sixty-five years of age or older increased 89% and the number 85 years of age increased 232 %. (Bureau of Census. Current population report. 65 plus in America. Washington: US Government Printing Office; 1993).
In this series of articles, we have been describing the definable physiological parameters, which differentiate younger from older adults beyond actual age itself. In general, it appears that the process of aging involves a decline in the efficiency of various cells and tissues and systems. The real question is then what precipitates this decline in efficiency and can it be avoided. Memory impairment probably represents the most obvious change occurring both in the so-called physiological aging and in pathological aging.
One of the assumptions in biology is that normal cells can go through only a fixed number of divisions before they die, a process called senescence. The assumption leads to the conclusion that this accounts for the aging process. Harry Rubin, Professor of Molecular Biology at University of California, Berkeley wrote a review article in Mechanism of Aging and Development 1997; 98:1-35. The article entitled Cell aging in vivo and in vitro, presents evidence that cells "accumulate damage over a lifetime [that] results in gradual loss of differentiated function and growth rate". He rejects the notion of an intrinsic limitation of the number of cell divisions. It is the damage to cells over a lifetime that stimulates the effects of aging, which induces a gradual loss of differentiated function of the cells and growth rate. This stress (e.g. biochemical damage) on the cells reduces its capacity to multiply. It is not related to changes in hormonal states, blood flow or other system effects of aging. This is an important distinction for researchers to make in understanding what is aging. Reduce "the stress" and you prolong life.
Dr. Rubin believes that cells enter an altered stage of growth, due to stress, which renders them susceptible to cancer and other types of intrinsic events( caused or initiated by process that originates within the body) that can lead to death. Rubin states:"there is ample evidence for a decrease in stability of the genome with age which would help to account for the exponential increase in cancer with age. This does not rule out an additional need in many cases for multiple mutations to produce a fully autonomous cancer. More likely, both factors, and perhaps others, contribute to the age dependence of cancer incidence." What happens is that cells loss their capacity to control gene expression. It is this slowing down or loss that manifests itself as the aging process.
There are attempts by the body to deal with this process as result of the stabilizing feature of multcellularity in organs where metabolic cooperation among cells occurs. "Multicellularity also provides the opportunity for continuous selection of the least damage cells." (Rubin). The object then is to reduce the stress on cells to prevent the start of altered growth stages, manifested as aging.
It would seem that there is something in the architecture of the gene that relates in some way to longevity. Scientists have found that every chromosome has tails (telomeres) at its ends that get shorter as a cell divides. The telemere length is hypothesized to give some indication of how many divisions the cell has already undergone and how many remain before it becomes senescent. Is this the result of "stress" or a natural process? What would happen if we were able to stop this process? Continued cellular growth is seen in cancer where cells seem to be immortal. Is this the result of an abnormal gene product, telomere non-shrinkage, or other factors? Maybe if we understand the biochemistry of aging, we will have some of the answers, producing longer and healthier lives. The next part of this series will look at the healthy older person and what distinguishes that person from the rest of the population.
Part IV
As we reviewed the first three parts of this series, it became clear that there are a number of items that we did not make explicit about the aging process. While these statements are known by all, they have vast significance for the process of aging.
First and foremost, is the objective fact that biological aging affects everybody, evidencing itself overtly and covertly at different ages and in different organs and systems depending on a whole series of cascading effects. Secondly, it is a deleterious process, involving the functioning of cells and therefore organs and finally the organism itself. Thirdly, this process is subtle in most cases, usually manifesting itself when the changes become extreme, or not until the system as a whole is stressed. Fourthly, it is not known if the process of aging is a disease or a natural process of the organism i.e. is there a built in general death factor or if all disease is conquered will we achieve immortality.
As we age, the amount of stress required to cause a breakdown in the health of the organism falls. (This axiom is related to a definition of aging cited by Alex Comfort: Aging is characterized by failure to maintain homeostasis under conditions of physical stress, a failure which is associated with a decrease in viability and an increase in vulnerability of the individual.) See part III of this series for discussion of stress factors..
We also know that age-related changes that do occur have a limiting effect on a number of bodily functions. Changes in the lens of the eye lead to presbyopia; changes in the cochlea of the ear lead to presbyacusis; a reduction in the accuracy of maintaining posture increases the amount of sway in the standing positions etc.
The big research dilemma revolves around distinguishing between changes, which are associated with normal aging and those which are due to external or internal pathological effects. Osteoporosis is a good example of this problem. As every reader must know, this disorder predisposes an individual to bone fractures. It is generally regarded as an age-related disease, particularly severe in post- menopausal women. However, there are also a number of pathological conditions that predispose one to this disorder or are associated with the development of osteoporosis such as prolonged immobility, poor nutrition, and excessive alcohol intake or corticosteroid treatment.
Another prominent example of etiology is impairment in body temperature control. It is partly assumed to be due to the aging process but it may be made worse by cerebrovascular disease or the dementing process such as Alzheimers Disease.
Postural hypotension is another of those problems that have both age-related and pathological sources. What appears to happen in most of the age-related vulnerabilities is that physiological systems decline with age resulting in a shift in the accuracy of the body to control the chemical and cellular environment and thus leaving individuals more prone to diseases of aging. (Again see Part III of this series where we discuss the cumulative effects of stress on cellular division and the process of senescence.)
In fact, if one were to look at the presenting medical problems of the elderly, six symptoms would stand out: mental confusion, respiratory problems, incontinence, postural instability and falls, immobility and social breakdown. While they are problems of the elderly, no one has definitively shown robust evidence that they are age-related. It is mainly beyond the age of 75 and more particularly 85 years that frailty and the dependence associated with chronic illness becomes apparent. Yet, generally, these changes were going on for many years, at levels below which we are able to detect and associate conclusively with the age-related deterioration process. Conversations with medical personnel suggest that healthy elderly people quite often have laboratory test results which are slightly abnormal, but are not deemed significant. While there are many chance factors that may account for these "abnormalities", they may be precursors of cell or system age-related changes leading to expression of disease at a much later date. The sooner we identify signs of a disorder, the more likely treatment will be effective.
This leads us to the "health strategy" we suggest for all people: A medical checkup should include a full blood work-up, a biochemical profile, an estimate of serum electrolytes, a urine analysis for protein and sugar, and a baseline cardiogram and chest radiograph. By establishing a measurement baseline, future check-ups will alert you to changes that may be soft signs of deteriorating or degenerative processes. At the same time, the physician/patient relationship should be a collaborative one in which the doctor gathers and disseminates information and the patient is active in applying the healing, using knowledge of their needs in synergistic fashion with the information received. In this way the patient is empowered in the most important aspect of life, the patient's health.
A look at life expectancy charts indicates an increase of life expectancy throughout the twentieth century. This is associated with the external improvements in health including the improvement in hygiene and nutrition and the conquest of certain infectious diseases by the process of clean water, vaccination, antibiotics and other forms of medical treatment. While more can be done with explicit factors of illness, the balance is now fully in the corner of implicit factors including but not limited to a healthy life style.
This should not be construed as shifting the onus of responsibility to the individual. Achievement of health always is a collaborative process involving the individual, treating health professionals, industry and the government. The latter needs to play an important role in monitoring the environment, encouraging research and providing care to individuals in need of service.
Developing a unifying theory of aging is an important goal of the geriatric field. As one reviews the literature on theory of aging, one becomes aware of almost 100 theories which could be broken down to two main categories which tend to be mutually exclusive, but both probably contain parts of a meta-theory.
The first category relates to programming theories and involves genetic coding, incorporating the concept that progressive expression of the appropriate genes throughout life leads to the changes of aging and ultimately to death.
The second category, error theories, contend that environmental influences on the organism lead to errors in gene transcription and protein synthesis and that the steady accumulation of these errors are the cause of aging and death. Over a period of time, the organism is exposed to a series of stresses that lead to malfunctioning similar to what occurs in machinery over time i.e. structural stress.
Future parts of this series will discuss theories of aging in detail to give our readers knowledge, the most powerful tool one could have in their armentarium.
Please e-mail us any questions that you may have, and we will respond as quickly as we can. If you have no objection, we may post your question and our answer in our question and answer section of this site
neal
wizard in black
I've already decided that we're all going to meet in Hell. I think that people that really did shitty things in their lives are sent to a modified of the Cannibal Corpse forum (when it existed) and they are told they cannot flame at all. Now, that's punishment.
The rest of us end up at a Nevermore forum, only, of course, everything's on fire, and we're rotting.
The rest of us end up at a Nevermore forum, only, of course, everything's on fire, and we're rotting.
And if you've ever smoked weed in your life, you get a permanent "-neal" stuck at the end of your posts.
neal
wizard in black
PlatypusJesus
A Dead Sun Serenity
All they are doing is fucking with nature. Mankind has always wanted longer life. Hell, I want to live my life out, 75 or 80 years, then get the fuck off this planet. I don't want to live any longer than that. I want to find out what the afterlife is like. Then you say, "Well, what if there is no afterlife, then that means you died for no reason and could have lived longer." Well, if there is no afterlife and I just die, I want give a fuck because, well, I can't.
ledmag
New Metal Member
Tee
Satan's yoyo
dreaming neon darkspot
natures' retard
TrueBeliever
michael
This is not true (although I doubt it was serious). We die because the human body is incredibly inefficient and is one of the most poorly designed species ever to walk this earth. You're body will eventually deteriorate and since the human is too complex to survive, one little problem and we die. We've only existed for 20-30 thousand years which is nothing, species of dinosaurs were around for millions of years, and why? Because they were built to survive. A practical sized brain, bigass teeth and claws, and thick skin, they did not need all of the chemical reactions taking place that allow us to exist. Bacteria are even simpler, and they have been around for billions of years.
Skreemqueen
>:)=
PlatypusJesus
A Dead Sun Serenity
I wouldn't want to be immortal. I want to move onto another life. I wouldn't want to just keep living this one forever. And if you are the only immortal than everyone around you would die and you would just have to move on. And no matter who you found or who you fell in love with, they would die and you would be left to walk alone. Life would be a hell of a lot more melancholic than it is already. Plus, even if you were immortal, planet earth would soon be destroyed from mankind's greed. Then you would be left just to float in space. Sure it would be beautiful but it would take you forever to get somewhere. Of course, you have forever to get somewhere.
