Aging Myth

> The Myth of Senility
Myth: Older persons "naturally" grow more confused and child-like, become forgetful, and lose contact with reality. They become "senile".
Reality: Senility is an outdated term referring to abnormal deterioration in the mental functions of some older people, linking the process of growing old to symptoms of forgetfulness, confusion, and changes in behavior and personality.
Such an image is false, stereotypical, and is neither a normal sign of aging nor even a disease. The word "senility" implies an assumption about elderly people that, because they are old, they are also mentally deficient.
This insidious myth, still prevalent, discriminates by causing or promoting social isolation, dependency, and loss of independence.
> The Myth of Disability
Myth: Older persons with severe functional disabilities experience a greater number of associated diseases than those with less severe disabilities.
Reality: There is no correlation between the severity of a functional disability and the number of associated diseases.
While incidences of both increase with age, the number of diseases affecting a person does not equate with either the severity of a disability or the magnitude of functional loss.
Vigorous people can acquire several diseases and remain independent. Conversely, many older people with severe functional disabilities remain otherwise healthy.
> The Myth of Homogeneity
Myth: As we age, we lose our individual differences and become progressively more alike.
Reality: Aging does not affect us as a person; our personality remains fairly constant. Not only do we retain our individual differences throughout our lives, these differences become even more pronounced as we get older.
We generally become more like our youthful self; a talkative teenager, for example, becoming a talkative older person and a stubborn youngster carrying the trait of stubbornness into old age.
Except for changes in our physical appearance and experiencing more physical problems, being "old" feels no different from how we feel now or when we were young. In reality, an old person is a young person who has just lived longer.
> The Myth of Lonely Isolation
Myth: Older persons are abandoned by their families and forced to live out their lives in isolation, loneliness, and despondency.
Reality: Most older people do not live alone. Over half of thoseage 65 and older live with a spouse or with other relatives, while less than one in five live alone. Most of these, however, are women because women generally live longer than men.
> The Myth of Dependency
Myth: Elderly people become helpless and cannot take care of themselves.
Reality: The overwhelming majority of older people are not helpless and for the most part can and do take care of themselves.
Ninety-four percent live independently and enjoy many of the same activities as do younger people. It is very important to understand that very few older persons require specialized products.
Most want—and use—the same kinds of products and environments enjoyed by younger generations. Moreover, only 4 to 6 percent of all older people are institutionalized at any one time.
> The Rocking Chair Myth
Myth: As age increases we withdraw, become inactive, and cease being productive.
Reality: Healthy aging covers the spectrum from introspective disengagement to staying active for as long as possible.
Diminished capabilities and personal preferences also tend to affect our level of activity. These factors, coupled with personality differences, result in some of staying active while others disengage.
> The Myth of Inability
Myth: Older persons are forgetful, incapable of learning, and refuse to adapt to new ways.
Reality: Aging does not affect our ability to learn. The information processing literature does not support the idea that cognitive functioning declines with age.
While we may experience some difficulty with short-term (working) memory as we get older, our long-term memory generally remains sound.
Older persons do, however, tend to solve problems differently than younger persons, preferring to "think things out" rather than relying on "trial and error."
And while our reaction time increases with age and correlates with the complexity of a task, this increase is only measured in milliseconds.
> The Myth of Retirement
Myth: Most persons retire between ages 65 and 70.
Reality: Although the 1978 amendments to the Age Discrimination in Employment Act raised the mandatory retirementage to 70 for most workers, over 60 percent of us choose to retire early.
In fact, early retirement before the age of 65 has become a pattern ingrained in our society. Indeed, all indications point to this trend continuing; but this does not mean that people will stop working
Ageing
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This article is about human ageing. For other uses, see Ageing (disambiguation).

A human face showing signs of ageing

An elderly woman
Ageing (British and Australian English) or aging (American and Canadian English) is the accumulation of changes in an organism or object over time.[1] Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline. Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand. Research shows that even late in life potential exists for physical, mental, and social growth and development. Ageing is an important part of all human societies reflecting the biological changes that occur, but also reflecting cultural and societal conventions. Age is usually measured in full years — and months for young children. A person's birthday is often an important event. Roughly 100,000 people worldwide die each day of age-related causes.[2]
The term "ageing" is somewhat ambiguous. Distinctions may be made between "universal ageing" (age changes that all people share) and "probabilistic ageing" (age changes that may happen to some, but not all people as they grow older, such as the onset of type two diabetes). Chronological ageing, referring to how old a person is, is arguably the most straightforward definition of ageing and may be distinguished from "social ageing" (society's expectations of how people should act as they grow older) and "biological ageing" (an organism's physical state as it ages). There is also a distinction between "proximal ageing" (age-based effects that come about because of factors in the recent past) and "distal ageing" (age-based differences that can be traced back to a cause early in person's life, such as childhood poliomyelitis).[3]
Differences are sometimes made between populations of elderly people. Divisions are sometimes made between the young old (65–74), the middle old (75–84) and the oldest old (85+). However, problematic in this is that chronological age does not correlate perfectly with functional age, i.e. two people may be of the same age, but differ in their mental and physical capacities. Each nation, government and non-government organization has different ways of classifying age.
Population ageing is the increase in the number and proportion of older people in society. Population ageing has three possible causes: migration, longer life expectancy (decreased death rate), and decreased birth rate. Ageing has a significant impact on society. Young people tend to commit most crimes, they are more likely to push for political and social change, to develop and adopt new technologies, and to need education. Older people have different requirements from society and government as opposed to young people, and frequently differing values as well. Older people are also far more likely to vote, and in many countries the young are forbidden from voting. Thus, the aged have comparatively more political influence.[citation needed]
Contents
[hide]
1 Early observations
2 Senescence
3 Dividing the lifespan
4 Cultural variations
5 Society
5.1 Legal
5.2 Economics and marketing
5.3 Health care demand
5.4 Impact on prisons
6 Cognitive effects
7 Coping and well-being
7.1 Religion
7.2 Self-rated health
7.3 Retirement
8 Societal impact
8.1 Emotional improvement
9 Successful ageing
10 Theories
10.1 Biological theories
10.2 Non-biological theories
11 Prevention and reversal
12 Measure of age
13 See also
14 Notes
15 References
16 External links
[edit] Early observations
Ageing, despite being a universal human experience, was first formally studied in 1532 by Muhammad ibn Yusuf al-Harawi in his book “Ainul Hayat”, published by Ibn Sina Academy of Medieval Medicine and Sciences.[4] This book is based only on Ageing and its related issues. The original manuscript of “Ainul Hayat” was scribed in 1532 by the author Muhammad ibn Yusuf al-Harawi. There are 4 copies of this old manuscript reported in various libraries of the world. It is stated that this is the first text on ageing in the world. After collation of these existed 4 copies of the manuscript, Hakim Syed Zillur Rahman edited and translated the manuscript in 2007. In the edited book, one can find how amazingly the author 500 years back discussed all types of behavioral and lifestyle factors including diet, environment and housing conditions related to ageing. He also discussed what drugs could increase and decrease ageing.
[edit] Senescence

A map showing median age figures for 2001

An elderly man
Main article: Senescence
In biology, senescence is the state or process of ageing. Cellular senescence is a phenomenon where isolated cells demonstrate a limited ability to divide in culture (the Hayflick Limit, discovered by Leonard Hayflick in 1961), while organismal senescence is the ageing of organisms. After a period of near perfect renewal (in humans, between 20 and 35 years of age), organismal senescence is characterized by the declining ability to respond to stress, increasing homeostatic imbalance and increased risk of disease. This currently irreversible series of changes inevitably ends in death. Some researchers (specifically biogerontologists) are treating ageing as a disease. As genes that have an effect on ageing are discovered, ageing is increasingly being regarded in a similar fashion to other geneticly influenced "conditions", potentially "treatable."
Indeed, ageing is not an unavoidable property of life. Instead, it is the result of a genetic program. Numerous species show very low signs of ageing ("negligible senescence"), the best known being trees like the bristlecone pine (however Dr. Hayflick states that the bristlecone pine has no cells older than 30 years), fish like the sturgeon and the rockfish, invertebrates like the quahog and sea anemone[5] and lobster.[6][7]
In humans and other animals, cellular senescence has been attributed to the shortening of telomeres with each cell cycle; when telomeres become too short, the cells die. The length of telomeres is therefore the "molecular clock," predicted by Hayflick.
Telomere length is maintained in immortal cells (e.g. germ cells and keratinocyte stem cells, but not other skin cell types) by the telomerase enzyme. In the laboratory, mortal cell lines can be immortalized by the activation of their telomerase gene, present in all cells but active in few cell types. Cancerous cells must become immortal to multiply without limit. This important step towards carcinogenesis implies, in 85% of cancers, the reactivation of their telomerase gene by mutation. Since this mutation is rare, the telomere "clock" can be seen as a protective mechanism against cancer.[8] Research has shown that the clock must be located in the nucleus of each cell and there have been reports that the longevity clock might be located in genes on either the first or fourth chromosome of the twenty-three pairs of human chromosomes.
Other genes are known to affect the ageing process, the sirtuin family of genes have been shown to have a significant effect on the lifespan of yeast and nematodes. Over-expression of the RAS2 gene increases lifespan in yeast substantially.
In addition to genetic ties to lifespan, diet has been shown to substantially affect lifespan in many animals. Specifically, caloric restriction (that is, restricting calories to 30-50% less than an ad libitum animal would consume, while still maintaining proper nutrient intake), has been shown to increase lifespan in mice up to 50%. Caloric restriction works on many other species beyond mice (including species as diverse as yeast and Drosophila), and appears (though the data is not conclusive) to increase lifespan in primates according to a study done on Rhesus monkeys at the National Institute of Health (US), although the increase in lifespan is only notable if the caloric restriction is started early in life. Since, at the molecular level, age is counted not as time but as the number of cell doublings, this effect of calorie reduction could be mediated by the slowing of cellular growth and, therefore, the lengthening of the time between cell divisions.
Drug companies are currently searching for ways to mimic the lifespan-extending effects of caloric restriction without having to severely reduce food consumption.
In his book, 'How and Why We Age', Dr. Hayflick notes a contradiction to the caloric restriction longevity increase theory for humans, noting that data from the Baltimore Longitudinal Study of Ageing show that being thin does not favour longevity.
[edit] Dividing the lifespan

95 year old woman holding a five-month-old boy
An animal's life is often divided into various age ranges. However, because biological changes are slow-moving and can vary within one's own species, arbitrary dates are usually set to mark periods of life. The human divisions given below are not valid in all cultures:
Juvenile [via infancy, childhood, preadolescence, adolescence (teenager)]: 0-19
Early adulthood: 20-39
Middle adulthood: 40-59
Late adulthood: 60+
Ages can also be divided by decade:
Term
Age (years, inclusive)
Denarian
10 to 19
Vicenarian
20 to 29
Tricenarian
30 to 39
Quadragenarian
40 to 49
Quinquagenarian
50 to 59
Sexagenarian
60 to 69
Septuagenarian
70 to 79
Octogenarian
80 to 89
Nonagenarian
90 to 99
Centenarian
100 to 109
Supercentenarian
110 and older

People from 13 to 19 years of age are also known as teens or teenagers. The casual terms "twentysomething", "thirtysomething", etc. are also in use to describe people by decade or age.
[edit] Cultural variations
In some cultures (for example Serbian) there are four ways to express age: by counting years with or without including current year. For example, it could be said about the same person that he is twenty years old or that he is in the twenty-first year of his life. In Russian the former expression is generally used, the latter one has restricted usage: it is used for age of a deceased person in obituaries and for the age of an adult when it is desired to show him/her older than he/she is. (Psychologically, a woman in her 20th year seems older than one who is 19 years old.)
Depending on cultural and personal philosophy, ageing can be seen as an undesirable phenomenon, reducing beauty and bringing one closer to death; or as an accumulation of wisdom, mark of survival, and a status worthy of respect. In some cases numerical age is important (whether good or bad), whereas others find the stage in life that one has reached (adulthood, independence, marriage, retirement, career success) to be more important.
East Asian age reckoning is different from that found in Western culture. Traditional Chinese culture uses a different ageing method, called Xusui (虛歲) with respect to common ageing which is called Zhousui (周歲). In the Xusui method, people are born at age 1, not age 0, because conception is already considered to be the start of the life span,[citation needed] and another difference is the ageing day: Xusui grows up at the Spring Festival (aka. Chinese New Year's Day), while Shuo An grows up at one's birthday.
Further information: Birthday
[edit] Society
[edit] Legal
There are variations in many countries as to what age a person legally becomes an adult.
Most legal systems define a specific age for when an individual is allowed or obliged to do something. These ages include voting age, drinking age, age of consent, age of majority, age of criminal responsibility, marriageable age, age of candidacy, and mandatory retirement age. Admission to a movie for instance, may depend on age according to a motion picture rating system. A bus fare might be discounted for the young or old.
Similarly in many countries in jurisprudence, the defence of infancy is a form of defence by which a defendant argues that, at the time a law was broken, they were not liable for their actions, and thus should not be held liable for a crime. Many courts recognise that defendants who are considered to be juveniles may avoid criminal prosecution on account of their age, and in borderline cases the age of the offender is often held to be a mitigating circumstance.
[edit] Economics and marketing
The economics of ageing are also of great importance. Children and teenagers have little money of their own, but most of it is available for buying consumer goods. They also have considerable impact on how their parents spend money.
Young adults are an even more valuable cohort. They often have an income but few responsibilities such as a mortgage or children. They do not yet have set buying habits and are more open to new products.
The young are thus the central target of marketers.[9] Television is programmed to attract the range of 15 to 35 year olds. Mainstream movies are also built around appealing to the young.
[edit] Health care demand
Many societies in Western Europe and Japan, have ageing populations. While the effects on society are complex, there is a concern about the impact on health care demand. The large number of suggestions in the literature for specific interventions to cope with the expected increase in demand for long-term care in ageing societies can be organized under four headings: improve system performance; redesign service delivery; support informal caregivers; and shift demographic parameters.[10]
However, the annual growth in national health spending is not mainly due to increasing demand from ageing populations, but rather has been driven by rising incomes, costly new medical technology, a shortage of health care workers and informational asymmetries between providers and patients.[11]
Even so, it has been estimated that population ageing only explains 0.2 percentage points of the annual growth rate in medical spending of 4.3 percent since 1970. In addition, certain reforms to Medicare decreased elderly spending on home health care by 12.5 percent per year between 1996 and 2000.[12] This would suggest that the impact of ageing populations on health care costs is not inevitable.
[edit] Impact on prisons
As of July 2007, medical costs for a typical inmate in the United States might run an agency around $33 per day, while costs for an ageing inmate could run upwards of $100. Most State DOCs report spending more than 10 percent of the annual budget on elderly care. That is expected to rise over the next 10–20 years. Some states have talked about releasing ageing inmates early.[13]
[edit] Cognitive effects
Steady decline in many cognitive processes is seen across the lifespan, starting in one's thirties. Research has focused in particular on memory and ageing, and has found decline in many types of memory with ageing, but not in semantic memory or general knowledge such as vocabulary definitions, which typically increases or remains steady. Early studies on changes in cognition with age generally found declines in intelligence in the elderly, but studies were cross-sectional rather than longitudinal and thus results may be an artifact of cohort rather than a true example of decline. Intelligence may decline with age, though the rate may vary depending on the type, and may in fact remain steady throughout most of the lifespan, dropping suddenly only as people near the end of their lives. Individual variations in rate of cognitive decline may therefore be explained in terms of people having different lengths of life.[3] There are changes to the brain: though neuron loss is minor after 20 years of age there is a 10% reduction each decade in the total length of the brain's myelinated axons.[14]
[edit] Coping and well-being
Psychologists have examined coping skills in the elderly. Various factors, such as social support, religion and spirituality, active engagement with life and having an internal locus of control have been proposed as being beneficial in helping people to cope with stressful life events in later life.[15][16][17] Social support and personal control are possibly the two most important factors that predict well-being, morbidity and mortality in adults.[18] Other factors that may link to well-being and quality of life in the elderly include social relationships (possibly relationships with pets as well as humans), and health.[19]
Individuals in different wings in the same retirement home have demonstrated a lower risk of mortality and higher alertness and self-rated health in the wing where residents had greater control over their environment,[20][21] though personal control may have less impact on specific measures of health.[17] Social control, perceptions of how much influence one has over one's social relationships, shows support as a moderator variable for the relationship between social support and perceived health in the elderly, and may positively influence coping in the elderly.[22]
[edit] Religion
Religion has been an important factor used by the elderly in coping with the demands of later life, and appears more often than other forms of coping later in life.[23] Religious commitment may also be associated with reduced mortality,[citation needed] though religiosity is a multidimensional variable; while participation in religious activities in the sense of participation in formal and organized rituals may decline, it may become a more informal, but still important aspect of life such as through personal or private prayer.[24]
[edit] Self-rated health
Self-ratings of health, the beliefs in one's own health as excellent, fair or poor, has been correlated with well-being and mortality in the elderly; positive ratings are linked to high well-being and reduced mortality.[25][26] Various reasons have been proposed for this association; people who are objectively healthy may naturally rate their health better than that of their ill counterparts, though this link has been observed even in studies which have controlled for socioeconomic status, psychological functioning and health status.[27] This finding is generally stronger for men than women,[26] though the pattern between genders is not universal across all studies, and some results suggest sex-based differences only appear in certain age groups, for certain causes of mortality and within a specific sub-set of self-ratings of health.[27]
[edit] Retirement
Retirement, a common transition faced by the elderly, may have both positive and negative consequences.[28]
[edit] Societal impact
Of the roughly 150,000 people who die each day across the globe, about two thirds — 100,000 per day — die of age-related causes.[2] In industrialized nations, the proportion is much higher, reaching 90%.[2]
Societal ageing refers to the demographic ageing of populations and societies.[29] Cultural differences in attitudes to ageing have been studied.[citation needed]
[edit] Emotional improvement
Given the physical and cognitive declines seen in ageing, a surprising finding is that emotional experience improves with age.[citation needed] Older adults are better at regulating their emotions and experience negative affect less frequently than younger adults and show a positivity effect in their attention and memory.[citation needed] The emotional improvements show up in longitudinal studies[specify] as well as in cross-sectional studies[specify] and so cannot be entirely due to only the happier individuals surviving.
[edit] Successful ageing
The concept of successful ageing can be traced back to the 1950s, and popularised in the 1980s. Previous research into ageing exaggerated the extent to which health disabilities, such as diabetes or osteoporosis, could be attributed exclusively to age, and research in gerontology exaggerated the homogeneity of samples of elderly people.[30][31]
Successful ageing consists of three components:[32]
1. Low probability of disease or disability;
2. High cognitive and physical function capacity;
3. Active engagement with life.
A greater number of people self-report successful ageing than those that strictly meet these criteria.[30]
Successful ageing may be viewed an interdisciplinary concept, spanning both psychology and sociology, where it is seen as the transaction between society and individuals across the life span with specific focus on the later years of life.[33] The terms "healthy ageing"[30] "optimal ageing" have been proposed as alternatives to successful ageing.
Six suggested dimensions of successful ageing include:[17]
1. No physical disability over the age of 75 as rated by a physician;
2. Good subjective health assessment (i.e. good self-ratings of one's health);
3. Length of undisabled life;
4. Good mental health;
5. Objective social support;
6. Self-rated life satisfaction in eight domains, namely marriage, income-related work, children, friendship and social contacts, hobbies, community service activities, religion and recreation/sports.
[edit] Theories
[edit] Biological theories
At present, the biological basis of ageing is unknown. Most scientists agree that substantial variability exists in the rates of ageing across different species, and that this to a large extent is genetically based. In model organisms and laboratory settings, researchers have been able to demonstrate that selected alterations in specific genes can extend lifespan (quite substantially in nematodes, less so in fruit flies, and even less in mice). Nevertheless, even in the relatively simple organisms, the mechanism of ageing remain to be elucidated. Because the lifespan of even the simple lab mouse is around 3 years, very few experiments directly test specific ageing theories (most of the evidence for the ones listed below is correlative).
The US National Institute on Aging currently funds an intervention testing program, whereby investigators nominate compounds (based on specific molecular ageing theories) to have evaluated with respect to their effects on lifespan and age-related biomarkers in outbred mice.[34] Previous age-related testing in mammals has proved largely irreproducible, because of small numbers of animals, and lax mouse husbandry conditions. The intervention testing program aims to address this by conducting parallel experiments at three internationally recognized mouse ageing-centres, the Barshop Institute at UTHSCSA, the University of Michigan at Ann Arbor and the Jackson Laboratory.
Telomere Theory
Telomeres (structures at the ends of chromosomes) have experimentally been shown to shorten with each successive cell division. Shortened telomeres activate a mechanism that prevents further cell multiplication. This may be an important mechanism of ageing in tissues like bone marrow and the arterial lining where active cell division is necessary. Importantly though, mice lacking telomerase enzyme do not show a dramatically reduced lifespan, as the simplest version of this theory would predict.
Reproductive-Cell Cycle Theory
The idea that ageing is regulated by reproductive hormones that act in an antagonistic pleiotropic manner via cell cycle signalling, promoting growth and development early in life in order to achieve reproduction, but later in life, in a futile attempt to maintain reproduction, become dysregulated and drive senescence (dyosis).
Wear-and-Tear Theory
The very general idea that changes associated with ageing are the result of chance damage that accumulates over time.
Somatic Mutation Theory
The biological theory that ageing results from damage to the genetic integrity of the body’s cells.
Error Accumulation Theory
The idea that ageing results from chance events that escape proof reading mechanisms, which gradually damages the genetic code.
The Viral Theory of Aging
Known causes of cancer (radiation, chemical and viral) account for about 30% of the total cancer burden and for about 30% of the total DNA damage. DNA damage causes the cells to stop dividing or induce apoptosis. DNA damage is thought to be the common pathway causing both cancer and aging. It seems unlikely that the estimates of the DNA damage due to radiation and chemical causes has been significantly underestimated. Viral infection would appear to be the most likely cause of the other 70% of DNA damage especially in cells that are not exposed to smoking and sun light.[35]
Evolutionary Theories
Enquiry into the evolution of ageing aims to explain why almost all living things weaken and die with age. Exceptions such as rockfish, turtles, and naked molerat are highly informative.
Accumulative-Waste Theory
The biological theory of ageing that points to a buildup of cells of waste products that presumably interferes with metabolism.
Autoimmune Theory
The idea that ageing results from an increase in autoantibodies that attack the body's tissues. A number of diseases associated with ageing, such as atrophic gastritis and Hashimoto's thyroiditis, are probably autoimmune in this way. While inflammation is very much evident in old mammals, even SCID mice in SPF colonies still senescence.
Ageing-Clock Theory
The theory that ageing results from a preprogrammed sequence, as in a clock, built into the operation of the nervous or endocrine system of the body. In rapidly dividing cells the shortening of the telomeres would provide just such a clock. This idea is in direct contradiction with the evolutionary based theory of ageing.
Cross-Linkage Theory
The idea that ageing results from accumulation of cross-linked compounds that interfere with normal cell function.
Free-Radical Theory
The idea that free radicals (unstable and highly reactive organic molecules, also named reactive oxygen species or oxidative stress) create damage that gives rise to symptoms we recognize as ageing.
Reliability theory of ageing and longevity
A general theory about systems failure. It allows researchers to predict the age-related failure kinetics for a system of given architecture (reliability structure) and given reliability of its components. Reliability theory predicts that even those systems that are entirely composed of non-ageing elements (with a constant failure rate) will nevertheless deteriorate (fail more often) with age, if these systems are redundant in irreplaceable elements. Ageing, therefore, is a direct consequence of systems redundancy. Reliability theory also predicts the late-life mortality deceleration with subsequent levelling-off, as well as the late-life mortality plateaus, as an inevitable consequence of redundancy exhaustion at extreme old ages. The theory explains why mortality rates increase exponentially with age (the Gompertz law) in many species, by taking into account the initial flaws (defects) in newly formed systems. It also explains why organisms "prefer" to die according to the Gompertz law, while technical devices usually fail according to the Weibull (power) law. Reliability theory allows to specify conditions when organisms die according to the Weibull distribution: organisms should be relatively free of initial flaws and defects. The theory makes it possible to find a general failure law applicable to all adult and extreme old ages, where the Gompertz and the Weibull laws are just special cases of this more general failure law. The theory explains why relative differences in mortality rates of compared populations (within a given species) vanish with age (compensation law of mortality), and mortality convergence is observed due to the exhaustion of initial differences in redundancy levels.
Mitohormesis
It has been known since the 1930s that restricting calories while maintaining adequate amounts of other nutrients can extend lifespan in laboratory animals. Recently, Michael Ristow's group has provided evidence for the theory that this effect is due to increased formation of free radicals within the mitochondria causing a secondary induction of increased antioxidant defence capacity.[36]
Misrepair-Accumulation Theory: This very recent novel theory by Wang et al.[37] suggests that ageing is the result of the accumulation of "Misrepair". Important in this theory is to distinguish among "damage" which means a newly emerging defect BEFORE any reparation has taken place, and "Misrepair" which describes the remaining defective structure AFTER (incorrect) repair. The key points in this theory are:
There is no original damage left unrepaired in a living being. If damage was left unrepaired a life threatening condition (such as bleeding, infection, or organ failure) would develop.
Misrepair, the repair with less accuracy, does not happen accidentally. It is a necessary measure of the reparation system to achieve sufficiently quick reparation in situations of serious or repeated damage, to maintain the integrity and basic function of a structure, which is important for the survival of the living being.
Hence the appearance of Misrepair increases the chance for the survival of individual, by which the individual can live at least up to the reproduction age, which is critically important for the survival of species. Therefore the Misrepair mechanism was selected by nature due to its evolutionary advantage.
However, since Misrepair as a defective structure is invisible for the reparation system, it accumulates with time and causes gradually the disorganization of a structure (tissue, cell, or molecule); this is the actual source of ageing.
Ageing hence is the side-effect for survival, but important for species survival. Thus Misrepair might represent the mechanism by which organisms are not programmed to die but to survive (as long as possible), and ageing is just the price to be paid.
[edit] Non-biological theories
Disengagement Theory
This is the idea that separation of older people from active roles in society is normal and appropriate, and benefits both society and older individuals. Disengagement theory, first proposed by Cumming and Henry, has received considerable attention in gerontology, but has been much criticised.[3] The original data on which Cumming and Henry based the theory were from a rather small sample of older adults in Kansas City, and from this select sample Cumming and Henry then took disengagement to be a universal theory.[38] There are research data suggesting that the elderly who do become detached from society as those were initially reclusive individuals, and such disengagement is not purely a response to ageing.[3]
Activity Theory
In contrast to disengagement theory, this theory implies that the more active elderly people are, the more likely they are to be satisfied with life. The view that elderly adults should maintain well-being by keeping active has had a considerable history, and since 1972, this has become to be known as activity theory.[38] However, this theory may be just as inappropriate as disengagement for some people as the current paradigm on the psychology of ageing is that both disengagement theory and activity theory may be optimal for certain people in old age, depending on both circumstances and personality traits of the individual concerned.[3] There are also data which query whether, as activity theory implies, greater social activity is linked with well-being in adulthood.[38]
Selectivity Theory mediates between Activity and Disengagement Theory, which suggests that it may benefit older people to become more active in some aspects of their lives, more disengaged in others.[38]
Continuity Theory
The view that in ageing people are inclined to maintain, as much as they can, the same habits, personalities, and styles of life that they have developed in earlier years. Continuity theory is Atchley's theory that individuals, in later life, make adaptations to enable them to gain a sense of continuity between the past and the present, and the theory implies that this sense of continuity helps to contribute to well-being in later life.[19] Disengagement theory, activity theory and continuity theory are social theories about ageing, though all may be products of their era rather than a valid, universal theory.
[edit] Prevention and reversal
See Life extension
Several drugs and food supplements have been shown to retard or reverse the biological effects of ageing in animal models; none has yet been proven to do so in humans.
Resveratrol, a chemical found in red grapes, has been shown to extend the lifespan of yeast by 60%, worms and flies by 30% and one species of fish by almost 60%. It does not extend the lifespan of healthy mice but delays the onset of age-related disease and infirmity.[39] It works by enabling the gene SRT-1 which mimics the effect of calorie restriction, which in some animals has been shown to lengthen lifespan.
Small doses of heavy water increase fruit-fly lifespan by 30%, but large doses are toxic to complex organisms.
In 2002, a team led by Professor Bruce Ames at UC Berkeley discovered that feeding aged rats a combination of acetyl-L-carnitine and alpha-lipoic acid (both substances are already approved for human use and sold in health food stores) produced a rejuvenating effect.[40] Ames said, "With these two supplements together, these old rats got up and did the macarena. The brain looks better, they are full of energy - everything we looked at looks like a young animal." UC Berkeley has patented the use of these supplements in combination and a company, Juvenon, has been established to market the treatment.
In 2007, researchers at the Salk Institute for Biological Studies, identified a critical gene in nematode worms that specifically links eating fewer calories with living longer. Professor Andrew Dillin and colleagues showed that the gene pha-4 regulates the longevity response to calorie restriction.[41] In the same year Dr Howard Chang of the Stanford University School of Medicine was able to rejuvenate the skin of two-year-old mice to resemble that of newborns by blocking the activity of the gene NF-kappa-B.[42]
In 2008, a team at the Spanish National Cancer Research Center genetically engineered mice to produce ten times the normal level of the telomerase enzyme.[43] The mice lived 26% longer than normal.[44] The same year a team led by Professor Michael O Thorner at the [45] University of Virginia discovered that the drug MK-677 restored 20% of muscle mass lost due to ageing in humans aged 60 to 81. The subjects' growth hormone and insulin-like growth factor 1 (IGF-1) levels increased to that typical of healthy young adults.[46]
In 2009, a drug called rapamycin, discovered in the 1970s in the soil of Easter Island in the South Pacific, was found to extend the life expectancy of 20-month-old mice by up to 38%.[47] Rapamycin is generally used to suppress the immune system and prevent the rejection of transplanted organs. Dr Arlan Richardson of the Barshop Institute said, "I never thought we would find an anti-ageing pill in my lifetime; however, rapamycin shows a great deal of promise to do just that." Professor Randy Strong of the University of Texas Health Science Center at San Antonio said, "We believe this is the first convincing evidence that the ageing process can be slowed and lifespan can be extended by a drug therapy starting at an advanced age."
Also in 2009, the British Journal of Nutrition reported a study at Tufts University in Boston which showed that brain function and motor skills in aged rats could be improved by adding walnuts to their diet. The human equivalent would be to eat seven to nine walnuts per day.[48]
In September 2009, researchers at UC Berkeley discovered they could restore youthful repair capability to muscle tissue taken from men aged 68 to 74 by in vitro treatment with mitogen-activated protein kinase.[49] This protein was found to be essential for the production of the stem cells necessary to repair muscle after exercise and is present at reduced levels in aged individuals.
Ronald DePinho, a cancer geneticist at the Dana-Farber Cancer Institute and Harvard Medical School, published a paper[50] in Nature magazine in November 2010 which indicated that the organs of mice could be rejuvenated by feeding them a chemical which triggered the production of telomerase.
Shrivelled testes grew back to normal and the animals regained their fertility. Other organs, such as the spleen, liver, intestines and brain, recuperated from their degenerated state. Dr Lynne Cox of Oxford University said, "This paper is extremely important as it provides proof of the principle that short-term treatment to restore telomerase in adults already showing age-related tissue degeneration can rejuvenate aged tissues and restore physiological function."
In this experiment mice which could not produce telomerase naturally were grown to adulthood before being given a chemical "switch" which turned on telomerase production. Telomerase is also associated with the growth of cancerous tumours which could prevent anti-ageing treatments using this discovery.
[edit] Measure of age
The age of an adult human is commonly measured in whole years since the day of birth. Fractional years, months or even weeks may be used to describe the age of children and infants for finer resolution. The time of day the birth occurred is not commonly considered.
The measure of age has historically varied from this approach in some cultures. In parts of Tibet, age is counted from conception i.e. one is 9 months old when one is born.[51]
Age in prenatal development is normally measured in gestational age, taking the last menstruation of the woman as a point of beginning. Alternatively, fertilisation age, beginning from fertilisation can be taken.

Health of Elderly: Importance of Nursing and Family Medicine Care
Unal Ayranci M.D.
Specialist Family Physician
Medico Social Center
Osmangazi University
Meselik Eskisehir Turkey
Nurten Ozdag
Assistant Professor
School of Nursing
Osmangazi University
Meselik Eskisehir Turkey
Citation: U. Ayranci & N. Ozdag : Health of Elderly: Importance of Nursing and Family Medicine Care . The Internet Journal of Geriatrics and Gerontology. 2006 Volume 3 Number 1

Keywords: aging | elderly health | elderly care | nursing and family practice for elderly

Abstract
A large percentage of today's aging population continues to live independently despite a variety of chronic health problems. Both age and disease related changes that affect the elderly's image of themselves; societal values and life experiences also play a role. Health maintenance is an ongoing challenge for these people, their families and health care providers. Health care for a growing elderly population is also of concern throughout the world. Individuals may have different views regarding ageing and elderly, which reflect in the attitudes of people including aging person and of health care providers.

Careful assessment of the aging person's perception of his or her health, health practices, and knowledge of safety factors affecting their own health is an important part of primary care in all settings, for especially family practitioner (FPs) and nurses. Early detection of problems and early intervention can prevent more serious complications and enable older adults to maintain the highest possible level of wellness and function. Nurses and FPs possess the knowledge, skill and caring to build a powerful understanding-communication with the seniors and to design, to implement alternative cost-effective elder care environments or direct in home and facility services.

Introduction
Aging is a complex process that can be described chronologically, physiologically, and functionally. Authorities use various systems to categorize the aging population1. We all have a different view of what getting old means. Before we look at the attitudes of others, it is important to examine our own attitudes, values, and knowledge about aging. Our attitudes are the product of our knowledge and values. Our life experiences and our current age strongly influence our views about aging and old people. If we view old age as a time of physical decay, mental confusion, and social boredom, we are likely to have very negative feeling toward aging.1,2,3,4 It is important to separate fact from myth when examining our attitudes about aging. It is hard for young people to imagine that they will ever be old. Despite some cultural changes, becoming old retains many negative connotations. Many people do not know enough about the realities of aging and because of ignorance they are afraid to get old. This fear of aging and the refusal to accept the elderly into the mainstream of society is known as gerontophobia.1,5,6
Review and Discussion
By 2020 more than 1.000 million people aged 60 years and older will be living in the world, more than 700 million of them in developing countries.7 The impact of increased elderly population will be felt in shifting lifestyles, health needs, social policy and family responsibilities.4,7,8 As people live longer and the percentage of elderly in the population increases, society faces several major challenges. One of the most significant of these challenges involves meeting the health care needs of the aging population. Although most older persons are in basically good health, 80% of those over 65 have one or more chronic conditions.1,5, 9 Safety is a major concern when working with or providing care to the elderly. Falls, burns, poisoning, and automobile accidents are the most common safety problems among the elderly. FPs and Nurses can play an important role by helping the elderly person recognize their risk factors, by planning coping strategies to promote safety, and by modifying their environment to minimize the likelihood of injury.9,10,11
Research by the National Institute on Aging reports that older patients receive less information than do younger patients with regard to resources, health management, and illness management.1,11,12,13 Elderly people suffer at least one chronic health problem and multiple conditions. Mental health problems often go unrecognized but are significantly more frequent in later life and can influence the physical illness. Alzheimer's disease and cognitive impairment are principal reasons for institutionalization.10,11,12,13,14 The elderly experience acute, life threatening, medical conditions just as younger persons do, but acute episodes in the elderly are more likely to be associated with chronic conditions. It is estimated that 80% of the elderly live with chronic conditions such as arthritis, hypertension, diabetes, heart disease, and vision or hearing disorders. Most of those with chronic illness are able to meet their own needs; only 25% require any special type of care.1,3,11,15,16,17 When the elderly lose health and independence, they lose control over their own destiny and are at the mercy of others for care. More than two thirds of the elderly (68%) live independently in a family setting. About 5% are institutionalized, and this percentage increases with advancing age. It is estimated that 10% of the elderly will need some form of long-term care in the home.10,11,12,14,18
Problems related to medications are common in the elderly, and they are costly in terms of both time and money. Studies have revealed that as many as 17% of hospitalizations of persons over 66 years of age were related to adverse drug reactions. The methodology used to test drugs and to establish therapeutic dosages generally doesn't take into account the characteristics of the elderly. When considering the responses of the elderly to medication, it is more important to consider physiologic age than chronologic age.1,13,19Polypharmacy, is a common problem in the elderly. According to a recent survey the average institutionalized elderly person takes 7.5 medications. The safety of the older adult is the primary concern and nurses or FPs must take special precautions to ensure that drugs are administered safely.1,17,18,19,20,21,22
The elderly should be examined at least once a year by their FPs, and more often if known health problems exist. Physical examinations in the elderly should include evaluations of height and weight, blood pressure, and blood cholesterol levels, rectal examination, for women a pelvic examination, mammogram, and PAP test. For men a prostate examination and blood tests to rule out prostate cancer, vision, dental and hearing examinations need to be done on a yearly basis. Evaluation of joints, feet, and gait should be a part of the physical examination. Some problems require surgical correction, whereas others can be treated more simply using analgesics, anti-inflammatory medications, or physical therapy.4,22,23,24,25,26
Effective care for older patients requires an accurate assessment of the elderly's health status. Physical, psychological, social, and behavioral and health system factors may influence their health status. Functional health status includes: a) basic activities of daily living; dressing, feeding, bathing, toileting, transfer-moving inside and round the house, b) instrumental activities of daily living; shopping, laundry, cooking, housekeeping, taking medication, managing money, c) advanced activities of daily living; social activity, occupation, recreation. Cognitive function assessment includes: attention span, concentration, intelligence, judgment, learning ability, memory, orientation, perception, problem solving, psychomotor ability, reaction time, social intactness.1,27,28,29
Nurses and FPs must possess knowledge about common physical changes of aging systems affected, changes noted, their implications for health, changes in normal laboratory values and the normal structures and functions all of the body systems so that deviations from the norm can be detected.1,11,12,13,14,15,16,17,18,22The elderly's used medications, communication impairments, ethnic and cultural differences, and language barriers may affect psychological assessment. Psychological status may be affected by abuse or neglect by family members that may be poor hygiene, poor nutritional status, social isolation, lack of needed assistance with daily living, evidence of tampering with the elderly's finances, and failure to assist the older person to maintain his or her independence.1,3,25,26,27,28,29,30
Planning to meet health care needs of older patients may take place at the primary, secondary, and tertiary levels of prevention. The most cost-effective means of providing health care to elderly involves primary prevention. In planning health promotion for elderly include nutrition, hygiene, safety, immunization, rest and exercise, maintaining independence, and preparing for death. Secondary prevention measures are undertaken when health problems have occurred, and primary prevention is no longer possible. Skin breakdown, constipation, urinary incontinence, sensory loss, mobility limitation, pain, confusion, depression, social isolation, abuse and neglect, alcohol abuse, inadequate financial resources, communicable diseases are conditions to be dealt with at this stage. Tertiary preventive activities focus on preventing complications of existing conditions and preventing their recurrence. Whatever the level of prevention involved, health care for the elderly has three common goals: 1. Improved functional ability, 2. Increased longevity, 3.Increased comfort and decreased suffering.1,3,8,9,15,16,17,18,22,23,30
Community health nurses and physicians must be mindful to involve older patients and their families in the planning of care. Patient involvement in planning is also likely to enhance compliance with the plan. Noncompliance should be suspected when a person doesn't show the expected amount of progress toward wellness, or gets worse instead of better, or develops repeated or unexpected complications. Cognitive impairment, inadequate knowledge, inadequate resources, lack of transportation, fear, anger, decreased self-esteem, substance abuse, and conflict of beliefs or values are the factors related to noncompliance.1,3,11,15,16,17,18, 24,25,26,27,28,29
Nurses and FPs can help to reduce problems of the elderly patients by communicating with them and by gaining more in-depth information regarding their physical and emotional needs. They should provide emotional support, enhance personal control, and promote self-esteem when caring for the elderly. To maintain and promote the health of elderly, they need to be seen and respected with their past and family as a whole.1,3,6,8,11,14,15,16,23
The elderly patient's knowledge of the factors that promote health and the existing health maintenance practices should be assessed. A little encouragement and information about options can help stimulate the elderly person's interests on positive health maintenance behaviors (such as diet, safety, stress management, elimination, sleep, rest, exercise). Before discharge from a health care institution, the elderly should have a thorough explanation of what they need to do to maintain health, including when to see or call the physician; what medications are required and when they should be taken; how to perform home screening procedures (e.g. blood glucose monitoring, daily weights.) and how to keep records and monitor their health condition.1,3,5,9,15,16,17,18,25,26,27,28,29,30,31 Community health nurses and FPs should assist in identifying family or community resources that will promote health maintenance. Often a little assistance is all that is needed to enable an elderly person to live a healthy independent life style 1,3,14,16,23,30. Much can be done to enhance the health status of the elderly population, improve their quality of life, and decrease the health care costs associated with the needs of this population by the community health nurses and FPs.

Healthy Aging Tips
How to Feel Young and Live Life to the Fullest

As we grow older, we experience an increasing number of major life changes, including retirement, the loss of loved ones, and the physical changes of aging. How we handle these changes, as well as regular day-to-day stresses, is the key to aging well.
Healthy aging is about much more than staying physically healthy—it’s about maintaining your sense of purpose and your zest for life. While the specific ingredients of healthy aging are different for everyone, the common factors are good mental health and the ability to manage stress. Knowing the basic formula for healthy aging will help you live with meaning and joy throughout your senior years. In This Article:
Healthy Aging
Tips for coping with change
Tips for finding meaning and joy
Tips for staying connected
Tips for boosting vitality
Tips for keeping your mind sharp
Related links

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Finding and following your formula for healthy aging
Coping with change is difficult, no matter how old you are. The particular challenge for older adults is the sheer number of changes and transitions—including the loss of friends, family, your career, your health, and even your independence. It’s natural to feel those losses. But if that sense of loss is balanced with positive ingredients, you have a formula for aging well.
Healthy aging means continually reinventing yourself, finding new things you enjoy, learning to adapt to change, staying physically and socially active, and feeling connected to your community and loved ones. Unfortunately, for many, aging brings anxiety and fear instead. How will I take care of myself? What if I lose my spouse? What is going to happen to my mind? However, many of these fears stem from myths about aging that are exaggerated or simply untrue. The truth is that you are stronger and more resilient than you may think.
Myths About Healthy Aging
MYTH: Old age means poor health and disability.
Fact: There are some diseases that are more common in older adults. However, getting old does not automatically mean poor health or that you will be confined to a walker or wheelchair. Plenty of older adults enjoy vigorous health. Preventive measures like healthy eating, exercising and managing stress can help reduce the risk of chronic disease and fall risk later in life.
MYTH: Memory loss is an inevitable part of aging.
Fact: You may eventually notice you don’t remember experiences as easily as in the past, and memories may take longer to retrieve. However, significant memory loss is not an inevitable result of aging. Brain training and new learning can occur at any age. And there are many things you can do to keep your memory sharp.
MYTH: You can’t teach an old dog new tricks.
Fact: One of the more damaging myths of aging is that after a certain age, you just won’t be able to try anything new or contribute things anymore. Quite the contrary. Older adults are just as capable of learning new things, thriving in new environments, and sharing their wisdom and experience with many generations. If you believe in yourself and have confidence in yourself, you are setting up a positive environment for change no matter what your age.
Healthy aging: Tips for coping with change
As you age, there will be periods of both joy and stress. It’s important to build your resilience and find healthy ways to cope with challenges. This ability will help you make the most of the good times and keep your perspective when times are tough.
Focus on the things you’re grateful for. The longer you live, the more you lose. But as you lose people and things, life becomes even more precious. When you stop taking things for granted, you appreciate and enjoy what you have even more.
Acknowledge and express your feelings. You may have a hard time showing strong emotions, perhaps feeling that such a display is inappropriate and weak. But burying your feelings can lead to anger, resentment, and depression. Don’t deny what you’re going through. Find healthy ways to process your feelings, perhaps by talking with a close friend or writing in a journal.
Accept the things you can’t change. Many things in life are beyond our control. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems. Face your limitations with dignity and a healthy dose of humor.
Look for the silver lining. As the saying goes, “What doesn’t kill us makes us stronger.” When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.
Take daily action to deal with life’s challenges. When challenges seem too big to handle, sweeping them under the carpet often appears easier. But ignoring the problem doesn’t make it go away; it allows both the problem and your anxiety to build. Instead, take things one small step at a time. Even a small step can go a long way to boosting your confidence and reminding you that you are not powerless.
Depression is not a normal part of aging
The difficult changes that older individuals often face—such as the death of a spouse, retirement, or medical problems—can lead to depression, especially if you don’t have a strong support system. But depression is not a normal or necessary part of aging, and with treatment and support, you can get back to enjoying your golden years.
Read: Depression in Older Adults and the Elderly: Recognizing the Signs and Getting Help
Healthy aging: Tips for finding meaning and joy
A key ingredient in the recipe for healthy aging is the continuing ability to find meaning and joy in life. As you age, your life will change and you will lose things that previously occupied your time and gave your life purpose. For example, you may retire from your career or your children may move far away. But this is not a time to stop moving forward. Later life can be a time of exciting new adventures if you let it.
Healthy aging means finding activities that you enjoy
Everyone has different ways of experiencing meaning and joy, and the activities you enjoy may change over time. If you’re not sure where to get started, try some of the following suggestions:

Pick up a long-neglected hobby
Play with your grandchildren or a favorite pet
Learn something new (an instrument, a foreign language, a new game)
Get involved in your community (volunteer or attend a local event)
Take a class or join a club
Go on a weekend trip to a place you’ve never visited
Spend time in nature (take a walk, go fishing, enjoy a scenic view)
Enjoy the arts (visit a museum, go to a concert or a play)

The possibilities are endless. The important thing is to find activities that are both meaningful and enjoyable. Whatever your preference, taking time to nourish your spirit is never wasted.
Healthy aging through humor, laughter, and play
Laughter is strong medicine for both the body and the mind. It helps you stay balanced, energetic, joyful, and healthy. A sense of humor helps you get through tough times, look outside yourself, laugh at the absurdities of life, and transcend difficulties.
To learn more about how to harness its powerful effects, read Laughter is the Best Medicine: The Health Benefits of Humor and Laughter.
Healthy aging: Tips for staying connected
One of the greatest challenges of aging is how your support network changes. Staying connected isn’t always easy as you grow older—even for those who have always had an active social life. Retirement, illness, death, and moves can take away close friends and family members. And the older you get, the more people you lose. What’s more, getting around may be difficult.
But it’s important to find ways to reach out and connect to others. Loneliness and isolation are major threats to aging well. Having people you can turn to for company and support is a buffer against depression, disability, hardship, and loss.
The good news is that there are lots of ways to be with other people. It doesn’t matter what you do, so long as you get out of the house (if possible) and socialize:
Connect regularly with friends and family. Spend time with people you enjoy and who make you feel upbeat. It may be a neighbor who you like to walk with, a lunch date with an old friend, or shopping with your children. Even if you are not close by, call or email frequently to keep relationships fresh.
Make an effort to make new friends. As you lose people in your circle, it is vital to make new connections so your circle doesn’t dwindle. Make it a point to befriend people who are younger than you. Younger friends can reenergize you and help you see life from a fresh perspective.
Spend time with at least one person every day. You shouldn’t be alone day after day. Phone or email contact is not a replacement for spending time with other people. Regular face-to-face contact helps you ward off depression and stay positive.
Volunteer. Giving back to the community is a wonderful way to strengthen social bonds and meet others, and the meaning and purpose you find in helping others will enrich and expand your life. Volunteering is a natural way to meet others interested in similar activities or who share similar values. Even if you’re housebound, you can get involved by volunteering on the phone.
Find support groups in times of change. If you or a loved one is coping with a chronic illness or recent loss, it can be very helpful to participate in a support group with others undergoing the same challenges.
Healthy aging: Tips for boosting vitality
Don’t fall for the myth that aging automatically means you’re not going to feel good anymore. It is true that aging involves physical changes, but it doesn’t have to mean discomfort and disability. While not all illness or pain is avoidable, many of the physical challenges associated with aging can be overcome or drastically mitigated by eating right, exercising, and taking care of yourself.
It’s never too late to start! No matter how old you are or how unhealthy you’ve been in the past, caring for your body has enormous benefits that will help you stay active, sharpen your memory, boost your immune system, manage health problems, and increase your energy. In fact, many older adults report feeling better than ever because they are making more of an effort to be healthy than they did when they were younger.
Healthy aging: Tips for eating well as you age
As you age, your relationship to food changes along with your body. A decreased metabolism, changes in taste and smell, and slower digestion may affect your appetite, the foods you can eat, and how your body processes food. The key is to figure out how to adapt to your changing needs. Now, more than ever, healthy eating is important to maintain your energy and health.
Load up on high-fiber fruits, vegetables, and whole grains. Your whole digestive system is slower, so fiber is very important. Consume fiber-rich foods such as whole grains, fruit, and vegetables. They will help you feel more energetic and give you fuel to keep going.
Put effort into making your food look and taste good. Your tastebuds aren’t as strong and your appetite may not be the same, but your nutritional needs are just as important as ever. If you don’t enjoy eating like you used to, put a little more effort into your meals, including the way you flavor, prepare, and present your food.
Watch out for dehydration. Because of physical changes, older adults are more prone to dehydration. So make sure you are drinking plenty of fluid, even if you don’t feel thirsty. If you’re not getting enough water, you’re not going to be as sharp and your energy will suffer.
Make meals a social event. It’s more enjoyable to eat with others than alone. Invite people over. You can share cooking and cleanup duties.
For more tips, visit Nutrition for Seniors: Healthy Eating Tips for Older Adults.
Healthy aging: Tips for exercising as you age
Many older adults don’t exercise. However, exercise is vital for healthy aging. It helps you maintain your strength and agility, gives your mental health a boost, and can even help diminish chronic pain. Whether you are generally healthy or are coping with an ongoing disability or health problem, regular exercise will help you stay physically and mentally healthy and improve your confidence.
Check with your doctor before starting any exercise program. Find out if any health conditions or medications you take affect what exercise you should choose.
Find an activity you like and that motivates you to continue. You may want to exercise in a group, like in a sport or class, or prefer a more individual exercise like swimming.
Start slow. If you are new to exercise, a few minutes a day puts you well on the way towards building a healthy habit. Slowly increase the time and intensity to avoid injury.
Walking is a wonderful way to start exercising. Exercise doesn’t have to mean strenuous activity or time at the gym. In fact, walking is one of the best ways to stay fit. Best of all, it doesn’t require any equipment or experience and you can do it anywhere.
For more tips, visit Senior Fitness and Exercise: How to Gain Energy and Feel Stronger
Getting quality sleep: Tips for seniors
Many older adults complain of sleep problems, including insomnia, daytime sleepiness, and frequent waking during the night. But aging doesn’t automatically bring sleep problems. Learning and practicing healthy sleep habits may be all you need to, once again, get a good night’s rest.
Read: Sleeping Well As You Age: Healthy Habits To Help You Sleep
Healthy aging: Tips for keeping your mind sharp
There are many good reasons for keeping your brain as active as your body. Keeping your brain active and maintaining creativity actually may help to prevent cognitive decline and memory problems. The more you use and sharpen your brain, the more benefits you will get.
Try variations on what you know. For some people, it might be games. Other people may enjoy puzzles. Still others may enjoy trying out new cooking recipes. Find something that you enjoy and continue to try new variations and challenges. If you like crosswords, move to a more challenging crossword series or try your hand at a new word game. If you like to cook, try a completely different type of food, or try baking if you’ve mostly been cooking over the stove.
Work something new in each day. You don’t have to work elaborate crosswords or puzzles to keep your memory sharp. Try to work in something new each day, whether it is taking a different route to the grocery store or brushing your teeth with a different hand.
Take on a completely new subject. Taking on a new subject is a great way to continue to learn. Have you always wanted to learn a different language? Learn new computer skills? Learn to golf? There are many inexpensive classes at community centers or community colleges that allow you to tackle new subjects. Volunteering is also a great way to learn about a new area. Taking classes and volunteering is a great way to boost social connections, which is another brain strengthener.

THE AGING PROCESS
Topics at a Glance

How We Age
The Aging Process
Trends in the Elderly Population
Physical Activity
Prevention
Health Care Decisions and Issues
Talking to Your Healthcare Providers
Health Assessment
Health Care Settings
Community-Based Care
Hospitalization
Nursing Home Care
Complementary and Alternative Medicines
Drug Treatment
Elder Mistreatment
Ethical and Legal Issues
Insurance, Financing, and Costs of Health Care
Pain Management
Palliative Care and Hospice
Rehabilitation
Elder Health at Your Fingertips
Cancer
Diabetes
The Digestive System
Disorders of the Digestive System
Disorders of the Mouth
The Heart, Lungs, and Blood and Circulation
Anemia and Other Blood Disorders
Breathing Problems
Fainting (Syncope)
Disorders of the Heart and Circulatory System
High Blood Pressure
Hormone Disorders
Infectious Diseases
Joints, Muscles, and Bones
Back Pain
Falls
Foot Problems
Osteoporosis
Problems with Joints, Muscles and Bones
Walking Problems
Mental, Neurological, and Psychological Conditions
Anxiety
Delirium (Sudden Confusion)
Dementia
Depression
Diseases of the Nervous System
Dizziness
Mental Retardation
Personality Disorders
Psychological and Social Issues
Psychoses (Delusions and Hallucinations)
Sleep Problems
Substance Abuse
Nutrition
Sexuality and Sexual Concerns
Gynecological (Female) Disorders
Prostate Disease
Sexual Problems
The Senses
Hearing Loss
Vision Loss and Other Eye Diseases
The Skin
Pressure Ulcers (Bed Sores)
Skin Diseases
The Urinary System
Kidney Problems
Urinary Incontinence

As we age, our bodies change in many ways that affect the function of both individual cells and organ systems. These changes occur little by little and progress inevitably over time. However, the rate of this progression can be very different from person to person. Research in aging is beginning to find out the reasons for these changes and the genetic and environmental factors that control them.
Genetic and Environmental Factors
Healthy Lifestyle Behaviors
Cellular Changes Associated with Aging
Bodily Changes Associated with Aging
Changes in Height
Changes in Weight
Changes in Body Composition
Other Changes with Aging
Normal Aging and Disease
Changes in the Regulation of Body Systems
Genetic and Environmental Factors
The aging process depends on a combination of both genetic and environmental factors. Recognizing that every individual has his or her own unique genetic makeup and environment, which interact with each other, helps us understand why the aging process can occur at such different rates in different people. Overall, genetic factors seem to be more powerful than environmental factors in determining the large differences among people in aging and lifespan. There are even some specific genetic disorders that speed up the aging process, such as Hutchinson-Gilford, Werner’s, and Down syndromes. However, many environmental conditions, such as the quality of health care that you receive, have a substantial effect on aging. A healthy lifestyle is an especially important factor in healthy aging and longevity (see Prevention). These environmental factors can significantly extend lifespan.
Behaviors of a Healthy Lifestyle
Not smoking
Drinking alcohol in moderation
Exercising
Getting adequate rest
Eating a diet high in fruits and vegetables
Coping with stress
Having a positive outlook
Cellular Changes Associated with Aging
Aging causes functional changes in cells. For example, the rate at which cells multiply tends to slow down as we age. Certain cells that are important for our immune system to work properly (called T-cell lymphocytes) also decrease with age. In addition, age causes changes in our responses to environmental stresses or exposures, such as ultraviolet light, heat, not enough oxygen, poor nutrition, and toxins (poisons) among others.
Age also interferes with an important process called apoptosis, which programs cells to self-destruct or die at appropriate times. This process is necessary for tissues to remain healthy, and it is especially important in slowing down immune responses once an infection has been cleared from the body.
Different diseases that are common in elderly people can affect this process in different ways. For example, cancer results in a loss of apoptosis. The cancer cells continue to multiply and invade or take over surrounding tissue, instead of dying as originally programmed. Other diseases may cause cells to die too early. In Alzheimer’s disease, a substance called amyloid builds up and causes the early death of brain cells, which results in a progressive loss of memory and other brain functions. Toxins produced as byproducts of nerve-cell transmissions are also thought to be involved in the death of nerve cells in Parkinson’s disease.
Bodily Changes Associated with Aging
Our bodies normally change in appearance as we age.
Changes in Height
We all lose height as we age, although when the height loss begins and how quickly it progresses vary quite a bit among different people. Generally, our height increases until our late forties and then decreases about two inches by age 80. The reasons for height loss include the following: changes in posture changes in the growth of vertebrae (the bones that make up the spine) a forward bending of the spine compression of the discs between the vertebrae increased curvature of the hips and knees decreased joint space in the trunk and extremities joint changes in the feet flattening of the arches
The length of the bones in our legs does not change much.
Changes in Weight
In men, body weight generally increases until their mid-fifties; then it decreases, with weight being lost faster in their late sixties and seventies. In women, body weight increases until the late sixties and then decreases at a rate slower than that of men.
People that live in less technologically developed societies do not show this pattern of weight change. This suggests that reduced physical activity and changes in eating habits may be causes of the change in body weight rather than the aging process.
Changes in Body Composition
The proportion of the body that is made up of fat doubles between age 25 and age 75. Exercise programs may prevent or reverse much of the proportional decrease in muscle mass and increase in total body fat. This change in body composition is important to consider in nutritional planning and level of activity. The change in body composition also has an important effect on how the body handles various drugs. For example, when our body fat increases, drugs that are dissolved in fatty tissues remain in the body much longer than when our body was younger and more muscular.
Other Changes with Aging
Normal aging in the absence of disease is a remarkably benign process. In other words, our body can remain healthy as we age. Although our organs may gradually lose some function, we may not even notice these changes except during periods of great exertion or stress. We may also experience slower reaction times.
Normal Aging and Disease
Aging and disease are related in subtle and complex ways. Several conditions that were once thought to be part of normal aging have now been shown to be due to disease processes that can be influenced by lifestyle. For example, heart and blood vessel diseases are more common in people who eat a lot of meat and fat. Similarly, cataract formation in the eye largely depends on the amount of exposure to direct sunlight.
We should remember that there is a range of individual response to aging. Biologic and chronologic ages are not the same. In addition, body systems do not age at the same rate within any individual. For example, you might have severe arthritis or loss of vision while the function of your heart or kidneys is excellent. Even those aging changes that are considered "usual" or "normal" are not inevitable consequences of aging.
Changes in the Regulation of Body Systems
The way our body regulates certain systems changes with age. Some examples are listed below.
Progressive changes in the heart and blood vessels interfere with your body’s ability to control blood pressure.
Your body cannot regulate its temperature as it could when you were younger. This can result in dangerously low body temperature from prolonged exposure to the cold or in heat stroke if the outside temperature is too high.
There may be aging-related changes in your body’s ability to develop a fever in response to an infection.
The regulation of the amount and makeup of body fluids is slowed down in healthy older persons. Usual (resting) levels of the hormones that control the amount of body fluids are unchanged, but problems in fluid regulation commonly develop during illness or other stress. Also, elderly people don’t feel as thirsty after water deprivation as they did when younger.
What do these age-related changes in our body systems mean?
First, with advancing age, we become less like each other biologically, so our health care needs to be more individualized.
Body systems that can be minimally affected by age are often profoundly influenced by lifestyle behaviors such as cigarette smoking, physical activity, and nutritional intake, and by circumstances such as financial means.
Finally, it’s helpful to consider ahead of time our possible choices in case certain situations arise. For example, if you become less physically able to take part in an athletic activity you did before, is there a different activity you might enjoy? Are there things you might like to do to keep your mind active? More serious situations to consider might include death of a spouse, or if you find your abilities becoming more and more limited. Have you discussed how you would like to handle such situations and your wishes with your family?
It is important to remember that the ability to learn and adjust continues throughout life and is strongly influenced by interests, activities, and motivation. With years of rich experience and reflection, we can rise above our own circumstances. Old age, despite the physical limitations, can be a time of variety, creativity, and fulfillment.
The size and character of the elderly population in the United States is rapidly changing. These major demographic shifts have prompted numerous concerns in US social and health policy. Aging "baby boomers" (the generation born between 1940 and 1960) are expected to have major effects on our health and social service systems.
Increasing Numbers of Seniors
Trends in Lifestyle
Income
Education
Living Arrangements and Marital Status
Life Expectancy
Causes of Death
Trends in Health and Functioning
Diseases
Disability
Health Care
What About the Future? Increasing Numbers of Seniors
The number of senior citizens in the United States is rapidly increasing. During the 20th century, the US population under age 65 tripled, but those 65 and older increased by a factor of 11. The actual number of seniors grew from 3.1 million in 1900 to 33.2 million in 1994. Plus, this number is expected to more than double by the middle of the next century, to 80 million people. By the year 2030, about one out of every five Americans, or 20% of our population, will be a senior citizen.
The United States is not unique in its growing share of seniors. In many other developed countries, including Italy, Japan, Germany, Sweden, and the United Kingdom, the proportion of seniors to the rest of the population is even greater.
Half of the people 65 or older live in nine states, led by California, Florida, and New York. Currently, the senior US population is mostly white, but the fraction from other races is growing rapidly. Within the next 50 years, the number of elderly black Americans is expected to triple. The elderly Hispanic American population is growing at an even faster rate and may exceed that of the elderly black population within 30 years.
Trends in Lifestyle
Income
Improvements in the Social Security system and the introduction of Medicare have had important effects on the economic well-being of senior citizens in the United States. In the early 1960s, 35% of people 65 or older had incomes below the federal poverty level, and only 60% received Social Security pensions.
By the early 1990s, 93% of older people received Social Security retirement benefits, and 97% were covered by Medicare. Today, the percentage of seniors with incomes below the poverty line is about 10%.
Although the overall economic position of older people in the United States has improved significantly over the past 30 years, these gains have not been shared by all. For example, poverty rates are higher among certain groups of senior citizens, including:
Black Americans (26%)
Hispanic Americans (21%)
People who never finished high school (21%)
People living alone (21%)
People 85 and older (20%)
People living in central cities (14%)
People living in rural areas (13%)
Older workers continue to make up a smaller and smaller part of the US work force, and this trend is expected to continue. In 1950, 60% of men 65-69 years old worked; in 1990, only 28% of men in this same age group worked. Overall, in the early 1990s, just 16% of senior men and 8% of senior women were working. Today, more than half of those who continue to work do so part time, and mostly by choice rather than because of restricted opportunities for full-time work.
Education
One of the most dramatic changes among US senior citizens in the future will be level of education. Between 1970 and 1998, the percentage of those 65 and older who completed high school increased from 28% to 67%. By 2030, 83% of seniors will have completed high school. The percentage with a bachelor’s degree or more will have increased to 24% from the current level of 15%. Education is closely related to lifetime income, and people with more education generally are in better health and at lower risk of disability.
These better-educated seniors will likely be more demanding health care consumers. Personal computers and the Internet are being used more and more by baby boomers as a source of medical information. Of course, the accuracy and reliability of all information on the Internet, including information on health care and disease prevention, is a concern. Is the information being posted by a credible source? Is it up to date? These and similar questions should always be considered.
Marital Status and Living Arrangements
Most elderly people in the United States under the age of 85 are married and living with their spouse. Not surprisingly, because women in general have a longer life expectancy, elderly men are twice as likely to be married as are elderly women. Conversely, widowhood is much more common among elderly women.
Elderly people who live alone, often having lost a spouse, usually prefer to remain independent and continue living alone as long as their health (and finances) allow it. Many who live alone have families or friends nearby, and about three in five have lived in the same place for 10 years or more. However, these elderly people are more likely than those who live with others to feel lonelier and more isolated.
Life Expectancy
The maximum life span is the theoretical, longest length of life, excluding premature "unnatural" death. Life expectancy is defined as the average number of additional years of life that is expected for a member of a population. It can be a useful predictor of actual lifespan for a given individual. People almost always die of disease or accident before they reach their biologic limit.
The average life expectancy in the United States is currently highest for white women, followed by black women, white men, and black men. On average, women live longer than men, and whites live longer than blacks. Based on 1996 statistics, women who live until age 65 can, on average, expect to live to age 84. Those who live to age 85 can expect to live to age 92. The number of people living to 100 in the United States is difficult to estimate, but their numbers are certainly growing. For people born in 1899, the odds of living to 100 were 400 to 1. However, for people born in 1980, the odds improved substantially to 87 to 1.
Causes of Death
Nearly 75% of all deaths in the United States are deaths of elderly people. For many decades, heart disease, cancer, and stroke have been the leading causes of death among the elderly, accounting for 70% of all deaths in this age group. The next most common causes of death in people aged 65 and older are chronic lung disease, pneumonia and influenza, diabetes, accidental injuries, Alzheimer’s disease, kidney disease, and blood infections.
However, causes of death vary among subgroups. For example, in 1999, diabetes was the fourth leading cause of death among older Hispanic and black Americans, while ranking sixth for older white Americans. Alzheimer’s disease ranked sixth among all causes of death for white American women 85 and older, but was less common among black American women or American men of similar age.
Some causes of death usually associated with younger people are also of concern among elderly people. In the United States, older men die in car accidents at a rate two to three times higher than that of older women. The highest suicide rates among the elderly are in white men (43.7 per 100,000), who are more likely to commit suicide than die in a car crash.
Trends in Health and Functioning
Disease and disability is much more common in the elderly population than in people younger than 65. Some illnesses and disease, such as hip fractures or Parkinson’s disease, are virtually confined to the later stages of life. Other diseases, such as cardiovascular disease, malignant cancer, malnutrition, thyroid gland problems, and tuberculosis can be seen at any age, but are more common among the elderly.
Diseases
In the United States in 1995, 79% of people aged 70 or older had one or more of the seven arthritis
 high blood pressure
 heart disease
 diabetes
 lung diseases
 stroke
 cancer
Personal Views: At the same time, personal estimates of health status vary much more widely among older people than younger people. According to a 1997 Medicare survey, 20% of white non-Hispanic Americans 65-74 years old regarded their health as excellent, 32% as very good, 13% as fair, and 5% as poor. The percentages of people who viewed their health as poor or only fair increased with age, and were higher for older black and Hispanic Americans than for older white Americans.
Multiple Diseases: The likelihood of having more than one disease also increases as we age. Among people aged 65 and older, 30% have three or more chronic diseases. Having more than one disease complicates care in several ways. Sudden change or illness in one body system may stress another body system, making the interpretation of symptoms more complex. For example, it is more difficult to evaluate mental confusion in someone who also has a fever caused by pneumonia. Sometime, the symptoms of one disease may hide those of another. For example, someone who has arthritis may never be physically active enough to show symptoms of heart disease, making the heart disease difficult to recognize.
Multiple Treatments: Unfortunately, sometimes treatment for one illness can cause a problem with another illness. For example, using an over-the-counter medication may cause bladder problems in someone who previously had normal bladder function. It is important for you and your health care provider to recognize the possibility of having two or more conditions at the same time and to be alert for possible effects that any treatment may have on other conditions.
Another reason to be alert to medications that may aggravate other conditions is that older people appear to have a greater risk of adverse reactions to drugs (See also Drug Treatment). You can reduce this risk by carefully reviewing all the medications you are taking with your doctor. This should include both nonprescription (over-the-counter) and prescription medications. Your doctor can check to make sure all the medications are necessary and effective and reduce the possibility of an adverse reaction.
Disability and Activities of Daily Living
The word function, as used in the health field, refers to your ability to manage your daily routine–a critical issue for all of us. Manual ability in particular is closely associated with the ability to live independently. A person’s manual ability reflects the skills necessary to perform basic activities of daily living (ADLs) and is helpful in making decisions related to what type of assistance, if any, is needed. This means that an evaluation of your functional abilities can be useful in defining certain health needs.
In the United States, most people younger than 85 report no difficulty in ADLs. However, this decreases with age, so that 78% of those aged 85 and older report some difficulty. Older women have more limitations at all ages than do older men. There are also differences between racial and ethnic groups. For example, among people aged 70 and older, black Americans were 1.5 times as likely as white Americans to be unable to perform one or more ADLs.
Assistance from Others: Elderly people who need assistance with routine ADLs rely first and foremost on family. In 1995, three-fourths of people who helped elderly city dwellers (aged 70 or older) were unpaid or informal caregivers. Nine out of ten of these informal caregivers were family members (one-fourth spouses and about half children), and half lived with the elderly person. The use of paid helpers is consistently higher among older adults living alone and increases with age.
Can We Recover?: In the past, it has been assumed that disability is irreversible. However, recent studies show that up to one-third of people who have a disability in a basic ADL recover. The chance of recovering from a basic ADL disability increases if the person is younger than 85, is on a healthy diet, and is able to get around.
Health Care
Function versus Disease: It’s helpful to work with your health care provider in focusing on function as well as on diagnosis of disease. In fact, knowledge of the disability, rather than the underlying disease, can be more important in getting help. Your functioning can often be improved without even having a specific diagnosis. For example, treatment for loss of bladder control focuses on determining how to improve or completely restore bladder control, as well as on improving the person’s confidence and self-esteem. This treatment does not depend on knowing whether the loss of bladder control is due to a brain injury, a stroke, dementia caused by Alzheimer’s disease, or any other irreversible process. When your problems are treated in this way, both you and your health care provider can avoid the disappointment and frustration of not being able to define or cure the primary disease.
Doctor Visits and Hospitalization: On average, older adults go to the doctor more often than younger adults. People 65-74 years old go to the doctor about 10 times per year, while those 85 and older go to the doctor nearly 15 times per year.
Older adults are also hospitalized more frequently than younger people. However, the average length of hospital stay for older patients has been decreasing for some time, from about 12 days per stay in 1964 to slightly less than 7 days per stay in 1996. Diseases of the heart were the most common discharge diagnoses in the United States for older patients. Heart disease and stroke together accounted for more than one-fourth of all hospital discharges among people 85 and older. Cancer was the next most frequent discharge diagnosis, followed by pneumonia and bronchitis. Hospitalizations for broken bones were more common among women than men and accounted for nearly one out of ten discharges among people aged 85 and older.
Home Health Care: Home-health care, including medical treatment, physical therapy, and homemaker services, is an alternative to institutional care for older adults. Nursing care is the most commonly used service.
Prescriptions: Prescription drugs are a major part of medical treatment. In the United States, at least 80% of older adults take one or more prescribed medicines.
What About the Future?
One of the important, unresolved questions is whether our increased lifespan will be "good" years–in other words, can we live longer while still being active and free of disability? It is unlikely that one answer to this question can be applied to all older adults because of great variations in health and functioning, from the bedridden Alzheimer’s patient to the marathon runner.
Many other unresolved questions can also be answered only by the passage of time. For example, will the increasing numbers of older people with more education and longer lives contribute to the larger society, and in what ways? Also, can our health care system handler greater numbers of older adults? Some analysts fear that the great increase in the numbers of older people may strain our medical care system and the public programs that finance health care and retirement to the breaking point. However, others believe that improvements in health behavior, medical breakthroughs, and financial prosperity will diminish these threats.

PHYSICAL ACTIVITY
Physical activity is one of the most important and effective ways to prevent and treat certain health problems in older adults. Physical activity means that the body is using energy to move muscles. Exercise is a type of physical activity that is designed to improve fitness.
Your level of physical activity influences your risk of chronic illness, loss of function, dependence, and death. A number of things influence the specific effects of physical activity, including the type of activity and how often and how long someone performs the activity.
Health Benefits of Physical Activity
Preventing disease and death
Treating disease
Preventing loss of function and dependency
Lowering health-care costs
What is the Right Amount of Physical Activity?
Do I need to see my doctor before increasing physical activity?
How much should I exercise?
What if I can’t exercise a lot?
Do I need to work up a sweat?
What if I want to do more?
Health Benefits from Different Types of Exercise
Walking and aerobic activities
Stretching exercises
Reducing muscle loss related to age
Resistance training
Reducing osteoporosis, falls, and fractures
Balance training
Work with Your Doctor
Health Benefits of Physical Activity
Regular physical exercise is the best antidote to many of the effects of aging. Major benefits from regular exercise include the following: favorable effects on fats in the blood better handling of blood sugar improved breathing better endurance improved balance greater strength stronger bones improved sense of well-being clearer thinking better sleep
Studies are currently being done to show the benefits of exercise programs for increasing life expectancy and decreasing the risk of or delaying disability as long as possible.
Preventing disease and death
Regular physical activity has beneficial effects on most (if not all) organ systems and can prevent a broad range of health problems and diseases. For example, physical activity reduces the risks of heart disease, high blood pressure, diabetes, obesity, osteoporosis, and colon cancer. There is also much evidence that physical activity can reduce loss of muscle related to age, depression, injuries related to falls, and stroke. In addition, physical activity has been linked to a decreased risk of gall stones, sleep problems, and ability to fight off infections. Currently, investigators are studying whether inactivity might also be a risk factor for many types of cancer.
Regular physical activity also decreases the risk of dying from heart disease or other causes. In some studies, inactive older adults had death rates twice as high as those of active older adults.
Remember–even if a person has some health problems, exercise is still beneficial. For example, inactive, obese smokers can improve their health by increasing their physical activity, even if they continue to smoke and do not lose weight. In addition, even a little bit of exercise pays off, such as parking farther away from the grocery store and reducing the time spent sitting and watching television. You don’t have to join a gym to get healthier!
Treating disease
Physical activity has beneficial effects in the management of many chronic conditions in older adults. Physical activity can improve symptoms of depression, with one study suggesting that strength training can improve symptoms of depression as much as medication. Regular physical activity can also improve sleep. Exercise is a vital part of the treatment of arthritis, and studies have found that exercise reduces pain without causing damage in people who have arthritis of the knee. Exercise is also useful to lower blood pressure in people with high blood pressure, to reduce falls, and to improve bone strength in people with osteoporosis (brittle bones).
Numerous professional organizations have issued guidelines that recommend various types and amounts of physical activity adjusted for certain conditions such as cardiovascular disease, high cholesterol, high blood pressure, diabetes mellitus, osteoporosis, etc. In addition to these guidelines, in general, you should check with your health care provider before making a major change in your level of physical activity or starting an exercise program.
Professional Organizations/Groups with Guidelines for Physical Activity
National Institutes of Health Consensus Conference on Physical Activity and Health
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
American College of Chest Physicians with the American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines Panel
American Diabetes Association
American Geriatrics Society with the British Geriatrics Society and American Academy of Orthopaedic Surgeons
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
American College of Rheumatology
National Heart, Lung, and Blood Institute Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
National Institutes of Health Consensus Conference on Osteoporosis Prevention, Diagnosis, and Therapy
Preventing loss of function and dependency
Regular physical activity delays the loss of function and can keep you living independently longer. Research data show that physically active, nonsmoking women at age 65 can expect to remain functionally active for 18+ years, on average, compared with less than 13 years for similar inactive women. Higher levels of physical activity are also associated with fewer years of disability before death.
Exercise in older adults decreases functional limitations and increases quality of life. Inactive older adults who have lost some function probably benefit the most from increasing their level of exercise. However, at least one study suggests that healthy older adults also can improve function from exercising regularly.
What is the Right Amount of Physical Activity?
Older adults are the least physically active age group in the United States. Data from the Centers for Disease Control and Prevention show that about 35% of adults 65-75 years old and 46% of adults older than 75 years are inactive or sedentary. About 40%-45% of adults are not active enough, and only about 20%-25% of older adults are moderately active. On average, the activity levels of older adults have not improved much over the past decade.
Do I need to see my health care provider before increasing my physical activity?
Healthy adults with no symptoms of illness do not necessarily need a medical evaluation before increasing their level of activity. However, adults with chronic illness should consult their health care provider before making any major change in their activity levels. Your health care provider can help design a physical activity plan that is best for your specific needs. Your health care provider may also recommend additional medical evaluation to minimize your risk of possible injury related to exercise.
How much should I exercise?
A moderate amount of physical activity has major health benefits and is recommended for all adults, regardless of age. Regular day-to-day activities may provide enough activity for older adults. For example, these activities might include walking, gardening, or performing household chores. Traveling to an exercise class is not necessary. Indeed, surveys show that most older adults do not prefer this option. However, for people who are trying to increase their level of activity, exercise classes can be useful because they provide supervision, instruction, and motivation.
Again, many professional and government organizations, including the Centers for Disease Control and the American College of Sports Medicine, have recommendations for amounts of physical activity for adults. Although these recommendations vary in some specifics, nearly all agree that adults should include a total of 30 minutes of moderate physical activity in their daily routine.
What is meant by "moderate" activity?
Definitions of a "moderate" amount of activity differ, even among experts. A moderate amount of activity expends about 150-200 kcal (ie, calories) per day, over 30-45 minutes, on at least 5 days per week. In less technical terms, a common example of a moderate amount of activity is a brisk 30-45 minute walk, 5 days a week.
Moderate activity has also been defined based on maximal heart rate. Several equations have been developed to predict maximal heart rate:
Max heart rate = 220 minus your age
Max heart rate = 208 minus (0.7 _ your age)
Using these definitions, moderate activity for most adults (all ages) would increase heart rate to 70% of maximal. However, a realistic, practical goal for currently inactive older adults is 30-45 minutes of activity at 55% to 69% of maximal heart rate. In fact, inactive older adults may benefit from even less exercise at lower intensity.
For most older adults, exercise programs of moderate intensity that last longer are better than programs of high intensity that are short. One of the reasons for this it that the risk of injury is lower in moderate-intensity exercise, so people are better able stick with the program. Increasing activity level by running is not generally recommended for older adults (unless they have always been runners) because injuries are common. Running and other high-intensity activities carry a greater risk of both sudden cardiovascular problems and injury to bones and muscles. People are also less likely to continue this type of exercise program.
What if I can’t exercise a lot?
Although bouts of activity 30-45 minutes long, are recommended, several bouts as short as 10 minutes each may substitute for one 30- to 45-minute bout. Short bouts fit into daily schedules more easily. They are also often preferred by older adults who may have symptoms of conditions that limit exercise, such as arthritis pain.
Even low amounts of activity have important health benefits and are better than an inactive life style. For example, in the Nurses Health Study, about 10 minutes of moderate activity a day reduced the risk of cardiovascular events by over 20%. About 22 minutes of moderate activity a day reduced the risk by about 35%. The generally recommended activity level of about 30-45 minutes a day reduced the risk by more than 50%.
Also, function improved and disability lessened in exercise programs that result in only small improvements in fitness. In the Fitness, Arthritis, and Seniors Trial (FAST), 2%-4% improvements in aerobic fitness and leg strength resulted in 8%-10% improvements in functional limitations and disability. In another study of falls prevention in women 80 years and older, 90 minutes of walking per week combined with low-intensity weight training and balance training reduced falls by 50%.
Do I need to work up a sweat?
Some recommendations suggest that moderate activity must work up a sweat, but this advice is questionable. Whether activity causes perspiration depends on several factors, including the following: the duration of activity the temperature in the environment the person’s clothing the person’s sex
Monitoring either heart rate or symptoms with exercise is probably a better way to guide level of exercise than working up a sweat. In group programs, an exercise leader can help older adults monitor themselves to maintain moderate levels of exercise intensity.
What if I want to do more?
Moderate amounts of physical activity are enough to gain important health benefits. However, gaining even more health benefits is possible with more activity. Although the best amount of activity is not known exactly, older adults who already are (or who have become) moderately active may want to increase their level of activity (within reason) to maximize health benefits. The most important thing to remembering in increasing activity is to do a mix or variety of activities that improve all aspects of fitness, including endurance, strength, balance, and flexibility.
Also, remember that the total amount of exercise can be measured by the calories your body uses up. So long as the number of calories used up is about the same for less strenuous bouts of exercise that are done for a longer time as for more strenuous bouts that are done for a shorter time, the health benefits are similar.
Health Benefits from Different Types of Exercise
Walking and aerobic activities
Walking is the core activity in most exercise plans for older adults. It is, by far, the most common and popular form of physical activity for older adults. Walking reduces the risks of death and heart disease, as well as the risk of falling. Of course, some older adults prefer other forms of aerobic activity, such as swimming, biking, dancing, and racket sports.
Stretching exercises
Stretching exercises and other activities that improve flexibility are recommended for older adults. Flexibility can be increased by specific stretching exercises, by exercise programs that include stretching exercises, or by some daily activities such as walking. Current recommendations encourage stretching at the end of a bout of activity, or after gentle warm-up activities.
Reducing muscle loss related to age
Age-related loss of muscle is called sarcopenia. This condition contributes to functional limitations and dependence in older adults. We don’t completely understand why sarcopenia develops, but nerve damage, decreased blood supply, and injury to cells may be involved.
Several studies suggest that regular physical activity among older adults can prevent much loss of muscle mass. For example, in one study of 22 active older men, their fat-free mass (a measurement of the amount of muscle tissue) did not change over 6_ years. In a Finnish study, everyday physical activities, such as household work, walking, and gardening, maintained skeletal muscle strength well enough for independent living.
Resistance training
Isotonic resistance training is strength training using weight machines or free weights. It has been extensively studied and is recommended as a means of building muscle mass and counteracting sarcopenia. Strength training has become a standard part of many therapeutic exercise programs, including programs for heart and lung rehabilitation. It also improves function and joint symptoms of older people with arthritis. In addition, strength training can improve control of blood sugar in older adults with diabetes.
As a rule, older adults benefit from strength-training programs at moderate-intensity levels. These programs typically use free weights, such as weight cuffs or dumbbells. Typically, regular training for 3-6 months can increase strength by 10-30%. In general, 2 days per week of resistance training is enough, doing, for example, 8-10 exercises 10-15 times each. Even 1 day per week has some benefits. Strength training programs also improve overall physical function, including improved balance and gait and less risk of falling. Programs are inexpensive and are run in a variety of settings, such as nursing homes, senior centers, and residences.
Some older adults may want to go a step further and explore more strenuous or high-intensity resistance training. In high-intensity training, the resistance or weight is at least 70% of the maximal weight that a person can lift just once. Older adults involved in these programs can gain strength steadily for many months. Although with proper supervision, vigorous training appears safe (even for nursing home residents), it is time consuming and less practical because it requires weight machines or other major equipment. In addition, training at this level is not for everyone. It can cause low levels of muscle inflammation and, if improperly done, cause injury.
Reducing osteoporosis, falls, and fractures
Regular physical activity by older adults probably has some effect in slowing bone loss related to age. Resistance and high-impact exercises are probably the most beneficial for slowing bone loss but they may be associated with injury. Weight-bearing aerobic activities can also help maintain bone mass.
Increasing physical activity is regarded as an effective part of programs to prevent falls. Overall, exercise improves balance and reduces the risk of falls and hip fracture. Studies also suggest that even daily activities, such as walking and climbing stairs, can reduce the risk of hip fracture.
Balance training
Some types of balance training, such as tai chi, can improve balance in older adults and reduce the risk of falls. Some programs include separate balance exercises, such as standing on narrow bases of support (eg, a one-leg stand). Other programs include some stretching and strengthening exercises done in a way that also improves balance (see Additional Resources for more specific exercise info).
Balance exercises can increase in difficulty, with exercises becoming more difficult as balance improves. For example, ,a tandem-walk exercise (walking by putting one foot directly in front of the other) is easiest when holding onto a table. The same exercise becomes progressively harder with arms in any position, then with arms close to the body, and then with arms close to the body and holding a weight.
Work with Your Health Care Provider
Healthy People 2010 and the 1996 U.S. Preventive Services Task Force recommend that inactive adults should ask their doctor or other health care provider about increasing their physical activity. Counseling can have both short-term and long-term effects on increasing physical activity levels in adults. Physically active older adults are more likely to have received counseling to increase their activity, and they consistently identify physicians as a key source of advice about physical activity and exercise.
Your doctor or other health care provider can help you establish an activity program that is right for you. Key things for you to work on together include:
Evaluating your current level of physical activity.
Setting goals that consider your health status, preferences, and life style. Having these goals as a written agreement may increase your chances of sticking to the program.
Identifying and overcoming barriers to activity. Common barriers for older adults include symptoms of disease (such as joint pain or shortness of breath), concern about neighborhood crime, being too busy for a variety of reasons (including caregiver responsibilities), and the weather.
Identifying sources of support. These include social support (such as a walking partner), telephone follow up, community programs, and Web-based programs that provide encouragement by regular e-mail messages. Your health care provider may also help you identify resources, such as information sheets, seniors activity programs, shopping malls that open early for "mall walkers," etc, that could be useful to you.
Your health care provider can also counsel you about specific exercise techniques to enhance the safety and maximize the benefits of your chosen exercise program. PREVENTION
Disease prevention is even more important in older people than in younger people. Several important preventive activities can help people stay healthy and independent for as long as possible. With good, preventive health care on a routine basis, we can remain functioning longer and extend our lifespan. In other words, older Americans have considerable control over the quality of their health.
Preventive Services Recommended for People Aged 65 and Older
Screening For:
How Often
Depression (questionnaire)
First visit and periodically
Alcoholism (questionnaire)
First visit and periodically
Mental processes
Every year
Height and weight
At least every year
Blood pressure
At least every year
Vision testing
Every year
Hearing testing
Every year
Bone density measurement (a type of scan for bone health)
Women, at least once after age 65
Thyroid function blood test
Women, every year
Cholesterol, triglyceride levels (blood test)
Every year in people with previous heart attack, stroke, peripheral vascular disease, or chest pain
Glucose level (test for blood sugar) for diabetes
Every year (if risk factors, eg, high blood pressure)
Mammogram (breast x-rays)
Yearly up to age 70, and continue for those who have reasonable life expectancy
Pap smear (gynecologic/pelvic examination)
At least every 3 years
Not needed in women 65 and older if they have had normal Pap smears up to that age; if never tested before, may stop after 2 normal annual Pap smears
Test for blood in stool
Sigmoidoscopy, or
Colonoscopy
Every year
Every 3 to 5 years
Every 10 years
Prostate specific antigen (PSA blood test and rectal examination for prostate cancer
Men, yearly
Counseling about:
Stop smoking
Low-fat, well-balanced diet
Adequate calcium intake
Physical activity
Injury prevention
Regular dental visits Every visit
Every year
Every year
Every year
Every year
Every year
Immunization (vaccination) for:
Flu shot
Pneumonia shot
Tetanus booster shot
Every year
Once at age 65 (if healthy); repeat every 6-7 years
Every 10 years
Medication for:
Omega-3 fatty acids (fatty fish) to prevent heart attack and stroke
People with previous heart attack
At least twice every week
One aspirin every day
On average, a person who is 65 years old can expect to live another 16 years. A person who is 75 can expect to live another 10 years, and a person who is 85 can expect to live another 6 years. People 75-85 years old can also expect to be able to function independently for at least half of that period. In these age groups, our health care goal shifts from extending lifespan to postponing dependency. While preventing disease is still important, maintaining good health for older adults focuses on preventing a loss of function and supporting the abilities we need to remain independent. In other words, the focus changes to vitality, function, and quality of life (rather than just to preventing disease and surviving).

First-Level Prevention
Smoking
Exercise
Diet
Alcohol use
Cholesterol
Car accidents
Accidental injury
Dental checkups
Low-dose aspirin therapy
Vaccination
Second-Level Prevention
Cervical cancer
Breast cancer
Colon cancer
Prostate cancer
Alcoholism
Diabetes
Heart disease
Depression
Obesity or Weight loss
High blood pressure
Osteoporosis
Vision or Hearing problems
Cholesterol
Thyroid disease
Skin cancer
Dementia
Third-Level Prevention and Comprehensive Geriatric Assessment
Additional Resources
First-Level Prevention
First-level prevention is designed to stop disease before it starts (ie, to reduce the risk of getting a disease). In can include changes in behavior and habits, and it is also important to keep up to date on vaccinations.
Smoking
Cigarette smoking remains the single most preventable cause of death in the United States for both men and women. Quitting can increase life expectancy, lower the risk of heart disease, and improve lung function and blood circulation.
People who have stopped smoking found it helpful to do the following: set a quit date have scheduled reinforcement visits use self-help packages make visits to community-based programs for people trying to quit
Exercise
Exercise is an important way to prevent many types of health problems, including cardiovascular disease, falls, and depression. The health benefits from regular physical activity are probably greater in older adults than in younger adults. Exercise should be a regular, day-to-day activity. It does not need to be overly strenuous.
Walking is recommended for everyone who is physically able. Walking can be done almost anywhere and at no or very low cost. People who walk for about 30 minutes a day can improve their health. Even small amounts of exercise by those who are typically not very active can have health benefits.
Diet
Eating a well-balanced diet and maintaining a healthy weight is very important as we age. A regular review with your health care provider of the calories, fluid, cholesterol, fiber, sodium, and minerals in your diet is useful. The number of calories you eat should be balanced against the amount of energy you use. Saturated fats should make up less than 10% of total calories. Saturated fat intake can by limited by eating fish, chicken without skin, low-fat dairy products, and lean meats. However, certain fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon are high in fatty acids that contain omega-3, a compound that can help prevent heart attack and stroke. Older adults without heart disease are encouraged to eat a variety of fish (preferably fatty) at least twice a week. Other sources of omega-3 include oils and foods like flaxseed, canola and soybean oils, and walnuts. Whole grains, fruits, and vegetables are also highly recommended. Easy ways to reduce salt intake include cutting down on salt use at the table and limiting the use of prepared (eg, canned or packaged) foods. Women generally need to increase their calcium intake as they age. In addition to these general guidelines, you should consider individual counseling from a nutritionist, dietitian, or physician if you have specific health problems and dietary needs. (See also Nutrition.)
Alcohol Use
Alcohol is a problem for about 5% of people over 65 years of age. Drinking too much increases injuries, gastrointestinal illness, and liver disease. It can also cause potentially reversible mental illness. However, having one drink per day (eg, one beer, one mixed drink, or one glass of wine) can reduce risk of heart attack and stroke. Regardless, people who have memory problems should not drink any alcohol.
Cholesterol
Cholesterol continues to be a risk factor for heart disease as we age, along with smoking, high blood pressure, and lack of exercise. Eating a balanced, low-fat diet is beneficial for preventing heart disease as well as for preventing cancer and other forms of illness. People at higher risk, such as those who already have some heart disease, may benefit from further steps to lower cholesterol.
Car Accidents
Car accidents are the leading cause of fatal injuries in adults up to age 75. The crash rate for older drivers (adjusted for the actual miles that they drive) is higher than for any other age group except for drivers under 25. All drivers, of course, should wear seat belts and should not drink before driving. Older drivers may need to change their driving techniques and habits to adjust to certain changes associated with aging (eg, decreased vision). It’s sensible to take a refresher course to improve your knowledge and skills. Both driver education and retraining are offered through the American Association of Retired Persons (AARP) and the American Automobile Association (AAA). People with severe visual or hearing loss, dementia, or certain neurologic diseases should seriously consider not driving.
Accidental Injury
Accidental injury is the sixth leading cause of death among people 65 years old and older. Many of these injuries are related to falls and car accidents. A fall at home that causes serious injury might require hospitalization and possibly care in a nursing home or a rehabilitation facility. Your healthcare provider can offer advice about the following: ways to reduce the risk of falling safety-related skills and behaviors ways to remove hazards in your home
Everyday safety behaviors include: regularly wearing seat belts having regular driving tests not drinking alcohol before driving or operating machinery
Examples of ways to decrease hazards in the environment include: lowering the water temperature in your hot-water heater to prevent serious burns installing smoke detectors installing alarms and automatic shut-off features on appliances getting rid of or safely storing firearms
In addition to general home safety, additional precautions are necessary in special circumstances. For example, if someone in the household uses oxygen, do the patient and all caregivers know how to use and clean the equipment correctly? Are any other types of medical support equipment in use? If so, is the equipment in working order? Does everyone in the household know how to use it properly and safely? Does everyone know what to do if the equipment stops working?
A more formal evaluation of your home to help prevent injuries can also be done by a physical or occupational therapist.
Dental Checkups
Regular dental visits are important as we age. Many common problems can be found during regular dental visits, including infection in the gums, dry mouth, and cancer. Both daily brushing with toothpaste that contains fluoride and flossing are also necessary for good dental health.
Low-dose Aspirin Therapy
One regular-strength aspirin tablet every other day is recommended to prevent coronary heart disease, but only if you have two or more of the following risk factors: diabetes mellitus low HDL cholesterol (the "good" cholesterol) male gender severe obesity strong family history smoking Aspirin therapy can also lower your risk of a second heart attack. However, you should not take aspirin if you have uncontrolled high blood pressure, severe liver disease, ulcers, or any other condition that increases the risk of bleeding. Your health care provider can advise if aspirin therapy is recommended for you.
Vaccination
Although vaccination is most often thought of as being important for children, it continues to be important as we age. Medicare covers the costs of flu, pneumonia, and tetanus immunizations.
Flu shots: During influenza (flu) epidemics, the hospitalization rate for older people increases two to five times. Vaccination for the flu is necessary every year because the flu virus constantly changes. This means that the antibodies in our blood from previous infection or vaccination last year might not protect us this year or next.
Everyone 65 years old or older, or those under 65 who have other illnesses, should receive a flu shot every year between September and mid November. Medical personnel and caregivers for high-risk patients should also be vaccinated. Side effects are usually rare, but include fever, chills, aches and pains, and general feelings of ill health. People who are allergic to eggs or any part of the vaccine should not get a flu shot. If you should not get a flu shot, your healthcare provider can tell you about other options to prevent the flu. If you do get the flu, some oral medications are available that can reduce flu symptoms.
Pneumonia vaccine: Pneumococcal infections continue to be the leading cause ofpneumoniaand can contribute to disability and death. Of the more than 40,000 deaths caused by these infections each year, 80% are in people over 65 years old. Everybody 65 or older (and people younger than 65 who have other illnesses) should be vaccinated against pneumococcal diseases, such as pneumonia. Side effects after revaccination are rare and mild. If it has been 5 or more years since you were vaccinated and if you received that vaccination when you were younger than 65, you should be vaccinated again. If you are unsure if you have ever been vaccinated against pneumonia, it is best to be vaccinated again. This vaccine cannot totally preventpneumoniaand related diseases, but it is still recommended for older adults.
Diphtheria/Tetanus vaccine: Diphtheria and tetanus are rare but are associated with a high death rate. Over half (60%) of tetanus infections are in people 60 years old and older. So, older adults who have never been vaccinated should receive two tetanus shots, 1-2 months apart, followed by a third shot 6-12 months later. After that, tetanusboostershots should be given about every 10 years. After vaccination, there may be pain or swelling where the shot was given. Rarely, someone may have an allergic reaction. People who have had an allergic or other bad reaction to a previous tetanus shot should not be vaccinated again.
Second-Level Prevention
Second-level prevention refers to efforts to improve the health of people who already have a disease. It focuses on screening to detect disease early and to begin treatment as soon as possible. In addition to the general preventive activities, second-level prevention includes screening for specific diseases of aging.
Cervical Cancer
Almost half of new cases of serious cervical cancer, including deaths from cervical cancer, are in women 65 years old and older. All women who are or have been sexually active and who have not had a hysterectomy should have a Pap smear every 1-3 years. Women over 65 years old who have regularly had normal Pap smears in the past usually no longer need to have Pap smears. For older women who have never had a Pap smear, screening can be stopped after two normal annual Pap smears. Medicare covers Pap smears performed every 3 years.
Breast Cancer
Screening by having an annual examination and amammogramevery 1-2 years is recommended. In general, active older women with a life expectancy of 5 years or longer should have amammogramat least every 2-3 years. Women at high risk, such as those with a history of breast cancer or abnormal mammograms, should have amammogramevery year.Medicarecovers annual screening mammograms.
Colon Cancer
Older adults should be screened for colon cancer by having a diagnostic procedure called acolonoscopydone. In addition, your healthcare provider may recommend testing for blood in the stool that cannot be seen without a microscope (fecal occult blood testing) and possibly a sigmoidoscopy. (A sigmoidoscopy is a procedure that is similar to a colonoscopy, done to examine the colon).
Screening for colon cancer is especially important for people who have any of the following risk factors: a close relative (eg, parent, sibling) who has a history of colon cancer a history of cancer of the breast, ovaries, or uterus a history of an inflammatory bowel condition, polyps, or previous colon or rectal cancer
Medicare will cover a screeningcolonoscopyevery 10 years, fecal occult blood testing every year, and a sigmoidoscopy every 2 years.
Prostate Cancer
Screening for prostate cancer is controversial because the disease usually progresses very slowly. In addition, evidence to support the benefit of treatment for early disease is lacking. Only 1 in 380 men with prostate cancer die of the disease. Your doctor can advise you on whether or not you should be screened for prostate cancer.
Alcoholism
The CAGE questionnaire is often used to indicate signs of alcohol dependence or abuse in older people. Answering "yes" to any of the questions below suggests a drinking problem.
C Have you ever felt you should Cut down?
A Does others’ criticism of your drinking Annoy you?
G Have you ever felt Guilty about drinking?
E Have you ever had an "Eye opener" to steady your nerves or get rid of a hangover?
Diabetes
Routine screening for diabetes mellitus is recommended if you have risk factors such as obesity, a family history of diabetes, or diabetes mellitus that developed during pregnancy. Symptoms that indicate the need for testing include the following: being thirsty a lot of the time passing a lot of urine unintended weight loss
Sugar levels are routinely measured as part of many blood and urine tests. (See also Diabetes.)
Heart Disease
An electrocardiogram (ECG) is not an effective screening test for heart disease. However, cardiac stress testing may be useful before beginning an exercise program. If you have had a heart attack, controlling risk factors such as cigarette smoking, high cholesterol, and high blood pressure is very important to prevent another. In addition, drug treatment in the first 3 years after a heart attack seems to reduce risk of death. (See also Disorders of the Heart and Circulatory System.)
Depression
Depression is common in older adults, but treatment can be highly effective. To help determine if you are depressed, your health care provider might use the Geriatric Depression Scale. You will be asked to respond to a number of questions by answering "yes" or "no" based on how you felt over the past week. (See also Depression.)
Geriatric Depression Scale
Are you basically satisfied with your life?
Have you dropped many of your activities and interests?
Do you feel that your life is empty?
Do you often get bored?
Are you in good spirits most of the time?
Are you afraid that something bad is going to happen to you?
Do you feel happy most of the time?
Do you often feel helpless?
Do you prefer to stay at home, rather than going out and doing new things?
Do you feel you have more problems with memory than most?
Do you think it is wonderful to be alive now?
Do you feel pretty worthless the way you are now?
Do you feel full of energy?
Do you feel that your situation is hopeless?
Do you think that most people are better off than you are?
Obesity or Weight Loss
A calculation of body mass index (BMI), can be used to estimate your ideal weight. Your BMI is calculated by dividing your weight in kilograms by the square of your height in meters (ie, kg/m2). Definitions for obesity in men and women follow:
Men: BMI greater than or equal to 27.8 kg/m2
Women: BMI greater than or equal to 27.3 kg/m2
On the other hand, sudden weight loss can also be a problem. An unintentional weight loss of 10 pounds in 6 months can indicate malnutrition or a serious illness and should be discussed with your healthcare provider. (See also Nutrition.)
High Blood Pressure
The chances of developing high blood pressure increase with age. Treating high blood pressure in older adults can reduce the chance of stroke and heart attack. A normal systolic blood pressure (the first or top number) should be 140 or less. The diastolic blood pressure (the bottom or second number) should be 90 or less. High systolic blood pressure is more common than high diastolic blood pressure after age 65. It is often associated with a drop in blood pressure when the person stands up. To determine if this is the case for you:
Check your blood pressure after sitting quietly for 10 minutes
Stand up and check your blood pressure in the same arm after you have been standing for 2-3 minutes
In general, your standing blood pressure is the one to use in deciding if your blood pressure is normal.
Because blood pressure varies more as we grow older, it needs to be measured more often. In addition, older adults are more likely to have side effects from treatment, so they should be watched carefully if treatment for high blood pressure is started. If you are taking blood pressure medication and feel dizzy or lightheaded, you should contact your healthcare provider. (See also High Blood Pressure.)
Osteoporosis
Most women 65 years old and older should be screened for osteoporosis (thin or brittle bones) by having a bone density test. People who are at high risk of broken bones should have a bone density test at age 60. Your healthcare provider can explain the importance of getting enough calcium in your diet, stopping smoking, exercising, and avoiding falls. (See also Osteoporosis.)
Vision and Hearing Problems
Common eye diseases in older adults include glaucoma, cataracts, and macular degeneration. In glaucoma, the pressure within the eyeball increases, leading to gradual loss of vision. Cataracts develop when the lens of the eye becomes cloudy and blocks light from passing into the eye. In macular degeneration, vision loss begins in the center of the visual field and progresses slowly, ultimately leading to blindness. These three diseases and outdated prescription glasses account for most visual problems among older adults. (See also Vision Problems.)
Hearing loss can lead to a feeling of being isolated from others. You should tell your healthcare provider if you’re having any problems with hearing and ask whether a hearing aid would be helpful. (See also Hearing Difficulty.)
Cholesterol and Triglycerides
Correcting cholesterol and triglyceride levels lowers the risk of future problems in older adults who have evidence of blockage in their arteries (eg, a history of heart attack or chest pains). Keeping your levels of cholesterol and triglycerides within the normal range is important to reduce your risk of cardiovascular problems including heart attack and stroke. Guidelines are as follows:
Your LDL cholesterol (the "bad" cholesterol) should be less than 100 mg/dL.
Your HDL cholesterol (the "good" cholesterol) should be greater than 40 mg/dL.
Your triglycerides should be less than 200 mg/dL.
Treating healthy older adults who have mildly increased levels is not currently recommended.
Thyroid Disease
Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) both become more common as we age. Your healthcare provider might perform a blood test to screen for these conditions, especially in older women.
Skin Cancer
If any of the moles on your skin change in appearance, or if the appearance of your skin changes in general, you should be checked by your healthcare provider. People who are light-skinned or who have had skin cancer in the past have a high risk of developing skin cancer. They should limit the amount of time they spend outside in the sun and should wear protective clothing when outdoors. Do not hesitate to tell your healthcare provider if you notice a new skin spot or one that has changed shape, color, or size.
Dementia
Dementia should be detected as soon as possible because a combination of medications, education, and counseling can benefit both patients and their families. It is important to control risk factors such as high blood pressure and high levels of cholesterol and triglycerides. This may be helpful for patients with dementia caused by cardiovascular problems or Alzheimer’s disease. Staying mentally active by reading, learning new things, or working crossword puzzles may also help prevent dementia. It’s not a bad idea to play Jeopardy! (See also Problems with Remembering, Thinking, and Understanding.)
Third-Level Prevention
Third-level prevention refers to efforts to prevent disability from becoming worse. This is done by regular and thorough monitoring and treatment of disease, including rehabilitation. Third-level prevention is needed most for older adults who often do not seek care for common sources of disability. Your healthcare provider may recommend a comprehensive geriatric assessment.
Comprehensive Geriatric Assessment
The comprehensive geriatric assessment is one way to identify current medical problems, sources of disability, and needed future care. Usually, a team of healthcare providers is involved so that all areas of a person’s life are considered. Having a thorough assessment is especially important when our health status changes quickly, or when a change in living arrangements appears necessary. Using checklists of ways to support health in older adults helps us stick with any recommendations.
PSYCHOLOGICAL AND SOCIAL ISSUES
For young people, time seems to have no end. But, as time passes we suddenly realize that the number of remaining years is limited. The realization that we are growing old can be traumatic. Our ideas about and attitudes toward aging are very important in how well we cope with and enjoy the passing years.
Some psychological characteristics of aging get passed down from generation to generation through our genes. Others can result from real or perceived changes in our bodies as we age (eg, mental or physical limitations). Social and cultural differences also affect how we deal with aging. Men and women think about aging differently, because of biological, social, and psychological differences between the sexes. For example, women tend to live longer than men, so they generally experience more losses of family members and friends. All these factors influence our overall well-being as we age.
How Our Minds Change as We Age
Learning
Memory
Reaction time
Intelligence
Life skills
Stresses
Caregiving
Loss and grief
Changing roles as we age
Social status
Healthy Ways to Cope with Stress
Belief in yourself
Coping strategies
Social involvement
Spiritual or Religious Involvement
Healthy Behaviors
How Our Minds Change as We Age
Losing mental function is perhaps the most feared aspect of aging. In fact, the fear itself often begins to wear down our quality of life. We begin to believe the stereotype that we are losing (or will lose) our mental function. T his can lead to loss of self-esteem and withdrawal from others. However, mental function does not have to decrease with age. Our fears are usually groundless.
Learning
The ability to learn continues throughout life, although we may learn in different ways as we age. Older people often require more time and effort to absorb new information. We may need to read instructions more carefully to be able to organize and understand new information. As we get older, we tend to avoid learning things that are not meaningful or rewarding to us, or that cannot be linked to one of our other senses, such as sight or hearing. The reasons for these changes in learning are not known, but they may be partly caused by changes in our sight, hearing, and other senses that we use for memory.
Memory
Older people may have trouble remembering some things, but not others. Short-term memory (ie, less than 30 minutes) worsens as we age. Although we often hear that long-term memory (weeks to months) also worsens as we age, this may depend more on getting information into our memory, rather than remembering it later. Very long-term memory (months to years) is basically permanent, collected through a lifetime of day-to-day education and experience. This type of memory increases from the age of 20 to about the age of 50 and then remains essentially the same until well after 70.
Most of us learn to adapt to changes in learning and memory. We slow down and do things more carefully. We think about things a little longer to remember them. We may avoid new or strange environments. As a result, any memory losses may not even be noticed until we experience a major life change, such as moving or the death of a spouse.
Reaction time
As we age, we tend to process information at a slower pace. This means it takes longer to figure out what is going on and what to do about it (if anything). Most of this "slow down" is caused by changes in the nervous system over time. We tend to slow down even further when doing tasks that require more thought or are more complicated. When an event is a surprise, we are particularly slow to respond. However, older people tend to make fewer mistakes in their responses than younger people.
Intelligence
Whether intelligence declines as we age is hotly debated. Although overall intelligence stays about the same throughout life, older people don’t do as well as younger people on many standardized intelligence tests. In formal tests of performance, older people also slow down with age–but, they make fewer mistakes. This is because we learn to value correctness as we age. So although we may be slower to respond, our answers are more accurate. We tend to be more cautious and less willing than younger people to make a mistake in judgment, which is a valuable characteristic in many real-life situations.
Life skills
You should keep in mind that most intelligence tests do not address things that we deal with in our daily lives. For example, older people tend to do better than younger people on tests that deal with practical activities, such as using a telephone directory. In fact, as we age, most of us get much better at being able to manage our daily affairs. It is usually only in times of stress or loss that we may be pushed beyond our limits, and having a support network to help us cope is very important. Older adults can continue to gain support, care, respect, status, and a sense of purpose by interacting with younger people. And younger people can learn from the experience, cultural meaning, stability, and continuity of older people.
Stresses
Older adults often must face a great number of stresses that can be caused by a broad range of events and situations. Stresses can be physical or social. They can be an ongoing part of day-to-day life, or caused by sudden traumatic events. Common stresses for older people include the following: diseases or health conditions, possibly chronic (eg, arthritis) perceived loss of social status after retirement death of a spouse
Stress often affects our physical health and can have an even stronger effect on our mental well-being. Too much stress can be associated with a number of psychological and physical conditions, such as anxiety, headaches, and ulcers.
Caregiving
Chronic diseases and conditions affect most older adults. Family members, especially spouses, are most often the caregivers. More than 44 million Americans (mostly women) care for family members of all ages. Many older adults are also caregivers for another family member.
Although caregiving can be rewarding, it is also very stressful. Caregivers have twice the risk as others for mental and physical health problems (eg, burnout, substance abuse, depression, etc). They are also more than twice as likely to be taking medications to relieve anxiety or stress. Social isolation, family disagreements, and financial hardships are common problems associated with long-term caregiving.
Caregivers can benefit greatly from training, information, and support. Programs that provide education, counseling, and behavioral therapy can decrease the stress of caregiving. Support groups for individuals with specific diseases (eg, Alzheimer support groups) often have information about support programs for caregivers.
Loss and grief
As we get older, the death of friends and family becomes more common. Losing and grieving for a spouse is one of the most traumatic situations commonly faced by older adults. More than 1 million spouses (mostly women) were widowed in the United States in 2003. This number is estimated to increase to 1.5 million every year by 2030. Other losses that may also cause grief include loss of sight or hearing and losses in function caused by illnesses (eg, trouble walking from arthritis). These and other negative life events place a heavy burden on older adults.
Most people grieve intensely for 6-12 months after a major loss. Generally, we feel depressed and withdraw from others. After about a year, we begin to accept the loss and start to interact more with friends and family. Going through the grieving process is an important part of emotional healing, and we shouldn’t try to ignore it or pretend it isn’t there. Getting treatment for depression can also help avoid the mental and physical health problems associated with a grieving process that goes on far longer than usual. (See also Depression and Other Mood Disorders.)
Changing roles as we age
People shift through many roles throughout their lives. We are children, parents, friends, workers, patients, students, sports enthusiasts, artists, etc. One of the most dramatic changes involves retirement. When older adults retire, they leave work and social roles that likely provided economic rewards as well as social status.
In addition, older people may find that there are changes in their personal relationships after retirement. For example, spouses may find themselves spending much more time together than they ever did before. Older parents may add the role of grandparent or even great-grandparent, which brings both new rewards and new demands.
Losses in function may place older adults in the position of asking for help, rather than providing it. Similarly, another’s losses may place someone in a caregiving role. These role changes can be stressful and affect mental and physical health.
Social status
Many social factors affect how we think about ourselves and how others think about us. Our sex, race, and economic status all affect our real and perceived social status. These factors also can affect the resources that are available to us to help cope with aging and health. For example, it’s difficult for poorer people to use support programs or community activities that cost money. Ethnic or cultural backgrounds may also have a major effect on our outlook and how we deal with situations. For example, women from some cultures do not feel comfortable exercising in public.
Many people are uncomfortable discussing some illnesses. Others may agree to only those treatments that are acceptable in their culture. Some cultures view hospice care as a wish to bring about the death of the person. Similarly, a procedure like autopsy may strongly violate certain cultural or religious beliefs.
Healthy Ways to Cope with Stress
Everyone must learn to manage both the stresses caused by major life events and the routine stresses of day-to-day life. Too much stress can greatly affect our physical health and ability to function, as well as our mental health and overall well-being. This includes enthusiasm for life and the ability to enjoy social interactions.
Problems caused by stress often relate to how we deal with the stressful situation. There are positive ways to deal with stress, even when the stress is beyond our control (eg, the death of a loved one). Learning positive behaviors can improve how we understand and cope with stress. For example, we can learn how to take more control of a stressful situation. We can also become more aware of social services and programs that are available. Family counseling and therapy can also strengthen social relationships with family and friends.
Belief in yourself
One of the best ways to cope with all kinds of stress is through a strong belief in yourself and your ability to deal with situations. Believing in yourself has many positive effects on health, both physical and mental. The way a person deals with a stressful situation has a big effect on what happens and how he or she feels about it. This is true for many kinds of stress, including those related to disease, loss in function, and changes in social roles. In fact, feelings of self confidence and personal control can go a long way toward improving function and overall quality of life, even in the face of physical disability.
Benefits of Believing in Yourself and your Ability to Control Situations
Lessens the negative effects of stress
Contributes to overall physical health and ability
Helps maintain overall function
Slows loss of function
Contributes to being able to make good decisions and follow through
Contributes to ability to get more done
More good news is that there are effective ways to strengthen your belief in yourself. Your sense of personal control and self confidence increases when you succeed at something new or when you see others like yourself succeed. Encouragement and empathy also can increase self confidence and a feeling of personal control. A number of training programs are available for improving performance in specific areas. Examples include programs to reduce the fear of falling or to stick with an exercise regimen after a heart attack.
Coping strategies
Coping strategies are emotional and mental responses that help us deal with stress. They provide positive reinforcement and reinforce self-esteem. There are many coping strategies that we can try. For example, thinking confidently and optimistically in the face of bad news might help us meet the challenge and increase the likelihood of a good result.
Another coping strategy that people tend to adopt with age is to cut down on the number and kinds of things they do, but to keep doing those activities that they like the most and do well. In other words, people spend more time doing a few selected activities and getting the most enjoyment from them. Although performance and abilities may lessen over time, you can continue to do the things you like, but perhaps you might simplify them. For example, a person who enjoys preparing fancy dinners might choose a simpler main course that he or she has prepared many times, along with several simple side dishes.
Social involvement
Participating in family and community activities is a major source of personal satisfaction. Being involved plays an important role in improving self-esteem and giving meaning to life. This is true for people of all ages, but is especially important for older adults.
Becoming more involved and finding ways to contribute to the broader world can improve overall well-being. There are many ways to get involved, including providing family assistance (eg, baby sitting), participating in group activities, volunteering, and even taking a job. Social involvement also helps to fight depression, which is more common among those who withdraw from their friends, family, and community. Social isolation is a strong risk factor for health problems and early death.
Social networks

Social networks provide many benefits that improve our overall well-being. Social networks provide emotional and physical support in times of crisis. For example, family and friends can support older adults through the death of a spouse or close friend. They can also provide help if an older adult experiences functional losses. However, we shouldn’t allow ourselves to rely completely on social networks. Older people, particularly men, who receive too much assistance may be less motivated to manage and overcome a disability. If a person receives too much help or isn’t encouraged to care for themselves, permanent disability can result. So although the social network is very helpful, the person should also be encouraged to regain maximal function.
Benefits of Social Networks
Less risk of early death
Better physical and mental health
Less risk of disability or decline in activities of daily living
Better chance of recovering ability to perform activities of daily living
Buffered impact of major life events
Greater feeling of personal control
Having social relationships that are enjoyable and meaningful is more important than having a large number of social interactions. Close personal relationships, such as a happy marriage or close relationships with family or friends, seem to be the most important. However, close relationships that are filled with disagreements and conflict work in the opposite direction. Having a large social network can have both positive and negative effects. A large social network offers the opportunity for greater involvement and contribution. However, a large social network also means a greater number of losses (death or disability) within the network.
Spiritual or religious involvement
Religion plays an important part in the lives of many older adults, who are generally more actively involved than younger people in religious services and practices. More than 50% of all older adults report frequent attendance at religious events. This involvement generally has overall benefits. Religious activity contributes to social interaction and encourages involvement.
Healthy behaviors
Healthy behaviors have positive effects on overall well-being at any age. Positive behaviors include the following: being physically active eating a healthy diet not smoking drinking alcohol only in moderation practicing relaxation or stress-reduction techniques
Although these are physical behaviors, they are also important psychologically and socially. For example, older adults with strong feelings of personal control and self-esteem are more likely to practice healthy behaviors. Similarly, healthy behaviors are likely to promote self esteem and feelings of accomplishment in older adults.
Strong social networks generally encourage healthy behaviors, making them easier and more enjoyable. Seeing friends and family gain health benefits from exercise encourages a person to increase his or her physical activity as well. For example, an older adult may be able to join a friend or family member on daily walks or tai chi classes.

Should We Cure Aging?
Aging fosters sickness and disability, increases human suffering, and makes us more likely to die. Yet there are a number of possible objections to the endeavor of curing aging. Most of these are unfounded myths and hence easy to disprove. This essay draws on my own lectures on the subject and attempts to answer the most commonly raised questions and concerns about a possible cure for aging and the work of gerontologists.
Key words: ageing, biogerontology, anti-aging medicine, eternal youth, gerontology, life span, rejuvenation

Myth #1: Aging is natural and so we shouldn't fight it
First of all, and contrary to popular belief, aging is not universal. A number of complex species, such as lobsters, rockfishes, and tortoises, do not show signs of aging. Therefore, aging is not a prerequisite to life. Aging is neither inevitable nor universal.
Secondly, humankind is, in a sense, a struggle against nature. We have antibiotics and vaccines because we don't want to be sick, which would be the natural outcome in most cases. Nature created smallpox and other diseases, yet we eliminated them for our good and nobody questions it. Yes, some people who drive cars, take medicines, wear glasses, receive e-mail, watch television, and don't have to kill their own dinner think life-extension is unnatural. I however think that life-extension is another adaptation of humans and one that, like many others, will make us live longer, healthier, and happier lives.
Myth #2: What's the point of extending life if we are old?
This is a common misconception about research on the biology of aging known as the Tithonus Error: In Greek mythology, Tithonus was a mortal who was granted immortality by Zeus but not eternal youth. As a result, Tithonus became increasingly debilitated and demented as he aged. Now, this is not what I aim to do. The ultimate goal of my work and that of many biogerontologists is to preserve and extend health, well-being, and life, not age-related debilitation. We aim not just to make elderly people live longer but--by improving their health--diminish, not extend, their suffering (see de Grey et al., 2002). What we want is to find ways to extend healthy lifespan by postponing disease and eventually eradicate all forms of age-related involution. In other words, to find a cure for aging, an intervention that permits us to avoid aging and all pathologies associated with it. More than improving the quality of life of the elderly, we want to avoid having elderly patients in the first place.
According to my calculations, if we were to cure aging that would result in an average longevity of at least 1,200 years in industrial countries. This assumes one would be forever young in body and mind. People would still die from accidents, infectious diseases, etc. After all, children and teenagers die too even though they are not yet aged.
Myth #3: A finite lifespan is best enjoyed
The ancient Greeks had an average longevity of 19 years and I'm pretty sure we are happier than them. In fact, longevity increased 50% over the past century and even so quality of life has clearly increased. Entertainment evolves and social adjustments occur. A cure for aging would not mean an eternal life for one could still die. It would mean an average lifespan of 1,200 years, but life would still be finite. In addition, people would always have a choice to end their lives. At present we don't have a choice of living past 122 years, which is the longest anyone has ever lived so far. With a cure for aging each of us would have a choice to live 100, 200, 1,000 or even more years.
Myth #4: Why should death be better than life?
This is actually an interesting philosophical question. Many societies, including Western societies, valor death in some circumstances--e.g., death in combat, death to save other lives, etc. Other societies are even more extreme and you can always argue that I don't know what is it like to be dead. As an atheist, I clearly favor life to death. It's true I won't feel death. But if I compare death to its opposite, I always choose life. For those who disagree suicide is always a solution.
Is curing aging against God or religion? As an atheist, I don't think I'm the right person to comment on the theological aspects of research on aging, but I do think the goal of medicine, and to some extent of modern society, is to diminishing suffering and improving health.
Myth #5: Not everyone would benefit from a cure for aging
The issue of justice is commonly raised when discussing life-extension. Of course it is impossible to predict the price a fictitious cure for aging would have. Yet a number of medical breakthroughs are not immediately available to everyone. The early antibiotics were available only to an elite and a number of present technologies, such as CAT scans or heart transplants, are not available to everyone. That is not a reason for us to ban pacemakers or regenerative medicine. We don't deny heart transplants just because they're not accessible to everyone. We can't deny health and life just because some people lack healthcare. Besides, even if curing aging is initially expensive, with mass production and widespread facilities one can expect it to be available to everyone, at least in industrialized nations.
When Vasco da Gama and Christopher Columbus explored the world they left death and injustice on the shores of Europe. Neil Armstrong walked on the moon without world peace and Tim Berners-Lee didn't wait for an end of poverty to invent the Internet. Yet all the discoveries and endeavors of these men benefited their societies and humankind in general. There are no ideal circumstances. Setting new limits and making new discoveries eventually improves the lives of everyone.
Myth #6: Economic disaster would result with the collapse of healthcare
No, of course not. In fact, curing aging and extending healthy lifespan would be profitable for nations. The economic value of increased longevity is estimated at $2.4 trillion per year for the US alone (The Economist, 3 June 2000). The greatest burden on healthcare comes from the elderly and the trend is for expenses with old age to increase as the percentage of people over 65 years-old rises worldwide (UN Programme on Ageing). If aging is not tackled, societies in the 21st will consist of a large proportion of frail, elderly people, which will result in a serious financial burden (Schneider, 1999). Therefore, curing aging would be economically sound. People would live longer but also work longer and thus be more productive. Without the declining years of old age, healthcare and the economy would benefit from a cure for aging.
One good book debating the economic impact of extreme life extension is:
"Coping with Methuselah: The Impact of Molecular Biology on Medicine and Society" edited by the Aaron, HJ and Schwartz, WB (2004). Brookings Institution Press, Washington.
Myth #7: Overpopulation would be a problem
When talking about life-extension it is intuitive we consider overpopulation as a possible problem. In the 1970s there was a current of thought known as the Mathusianism that predicted major problems due to overpopulation by the year 2000. These predictions failed miserably because their proponents did not take into account technological progress made in agriculture, etc. Therefore, we cannot see breakthroughs in aging research as isolated events but rather consider these in the overall evolution of the social organism. The world's population increased almost four-fold in the past century and yet today we have a life quality unparalleled in human history. In fact, population growth with a cure for aging should still be slower than during the "baby boom."
Overpopulation in some regions of the world, such as southeast Asia, may be aggravated by a cure for aging. Yet letting people die to control overpopulation is morally repugnant. If we cure aging and overpopulation becomes a problem in some regions, then we must find other solutions besides letting people die.
Myth #8: Human trials would be dangerous
This problem occurs with any other medical breakthrough. Following animal tests, human trials begin in a few people. Only after the security and quality of the product being tested is assured can the company commercialize it. Certain products can escape these regulations using a variety of legal stratagems, but that is a general problem in the biomedical industry, not specific of anti-aging research.
Myth #9: Humankind as we know it would change
Certainly, but that is not necessarily a "bad thing." Humankind changed considerably since the Roman Empire and yet those changes now allow us to live longer, happier lives. A cure for aging would reshape society but nothing suggests such changes would be negative to humankind. People do not exist to serve society. Society exists to serve people, to make people happier and fight solitude (see Thomas Hobbes's Leviathan). In the same way the world is a better place to live in due to the many changes that occurred in the past centuries, a cure for aging would make it an even better place thanks to the decrease in suffering and the increase in health. Although no-one can foresee the long-term consequences of a cure for aging, and there are potential problems such as intergenerational differences in wealth and status, society could profit. And people would certainly profit.
Myth #10: We should have other priorities on earth
Of course there are many problems and injustices in our world. Many nations face hunger, poverty, and widespread disease. Yet, as mentioned in regard to the justice issue on myth #5, this does not mean industrialized nations must abandon expensive medicines. Besides, the technology to solve poor countries' problems is already here--i.e., sustainable agriculture, vaccines, birth control, etc.--and it is up to these nations to implement them.
Aging is the major problem we face in our society. It is or will be the major cause of suffering and pain for me and the ones I love. This holds true for industrialized nations and Western civilization and that is why aging must be a top priority.
Myth #11: Overall, curing aging is ethically wrong
Not so. According to the principles of bioethics, like the principle of beneficence, since curing aging would benefit people, not harm them, it is not ethically wrong. Anti-aging therapies would serve to the amelioration of the many diseases for which old age is the major susceptibility factor. On the contrary, having a cure for aging and refusing to make it available to patients would result in pain and injury, clearly in contradiction with the principle of nonmaleficence. Even if we cure aging, individuals will still be able to choose whether they wanted to age or not, in accordance with the principle of respect for autonomy. If someone wants to continue aging despite a cure for aging being available, no-one can force him or her not to age. Likewise, if a cure for aging is proven safe and efficient then it should be available to all of those who wish to benefit from it.
Some bioethicists, such as Leon Kass and Francis Fukuyama, argue life-extension is immoral. Of course, since longevity increased 50% in the past century, we may already be living immoral lives just for opposing bacteria, viruses, and cancer when we should let them eat us alive. As I hope I made it clear above, curing aging is ethically the right thing to do.

The Psychology of Aging
Original Air Date: February 1, 1998
An examination of the perceptions and misconceptions about the aging process; how to live the best you can as long as you can; information about depression, an extremely misunderstood and misdiagnosed senior/caregiver affliction.
The Psychology of Aging
Depression

The Psychology of Aging
The major myths/misconceptions about aging
1. Getting old is a dead end - that there's no growth or potential for being actively engaged. Aging is not all loss and decline inevitably leading to sadness/depression. It does happen to some, but not to all. Most seniors are very much engaged.
2. Decline in mental function. This is the most frightening myth for most people. Fear of loss of independence in this way (or because of physical ailment) is at the root of all our myths and misconceptions about aging.
3. Old people are abandoned by their families. Not the norm at all. Most seniors have frequent contact with their children, siblings and friends.
The common denominator in all of the above is fear of losing independence.
Why do these myths/misconceptions arise?
They arise because we know someone to whom they have happened. As is human nature, we then tend to focus on that negative aspect. We tell ourselves, "That's what it's like to be old" when we see someone who's had a stroke, suffers from dementia, is in a wheelchair, etc.
We have a tendency to lump all seniors into one demographic group. But the term senior can cover a span of 40 or 50 years. We wouldn't dream of generalizing about the period of birth through age 50, so we shouldn't do the same with seniors. They are a very diverse group. In fact, as people grow older, they get more different from each other due to individual milestones: being widowed or other changing family circumstances, personality is more entrenched, etc. There is no common denominator among a given group of seniors other than age.
There is the myth of mental decline. We forget things even when we're younger. When we're younger, however, we accept/dismiss it as just having too much on our mind at a given time. But when we're old and forget things, we automatically blame age.
"Environmental/societal" factors contribute to the myths as well, like a crosswalk where even a very able-bodied person has trouble crossing before the light changes. The senior that holds up traffic trying to cross doesn't have a problem - the light just changes too fast for anybody. Things like too-small print on packaging, dim lighting in public areas, and grey-on-grey elevator buttons all set seniors up to "fail."
Why do we treat getting old as problem as opposed to a natural part of life?
Today, our society responds to situations or intervenes only when they are problems - when someone is in need. Therefore, if you are in need of some type of assistance and you are old, then aging is seen as the problem that has caused you to be in need. In other words, if you have a "need" for public intervention, then you must have "a problem."
How do different cultures differ in their views on aging?
North American culture embraces youth. By contrast, aboriginal people view the elderly as repositories of tradition and wisdom, and they are revered as a result. The Chinese view is very similar.
Older people in North America are often segregated, living in nursing homes or the like, and there is not as much interaction between generations as in some cultures.
Parents who were first-generation immigrants to Canada can often be disappointed when they've brought "old country" traditions and expectations, but their children have adopted the North American thinking in this regard.
The danger of myths and misconceptions vis-a-vis caregiving:
Projecting our misconceptions onto a cared-for loved one is HUGELY damaging. Attitude is the single most important factor in healthy psychological aging.
When we project a limiting myth onto a senior, it becomes self-perpetuating in that it (although it may be done with only good intentions) fosters dependence ("If I'm supposed to be frail and feeble at my age, then I must be frail and feeble...."). These myths rob the person of their opportunity to participate and be independent.
An example of this would be an adult child unilaterally deciding that Mom should move out of her house - that the stairs are too dangerous - even though Mom never considered it and doesn't see the problem.
There is a term called "dignity of risk," which refers to a person's entitlement to decide, if they are able, what risk(s) they will expose themselves to in the name of independence, etc.
Our reactions to decision-making capability are not good. Just because a person can't do one thing for him/herself (i.e. balance a cheque book) doesn't mean he/she can't do another, possibly related task (handle his/her own finances). (Lots of us can't balance our cheque books!)
Educate yourself if you're a caregiver! Learn what is a normal result of aging. Separate fact from fiction/myth.
How do people deal with the role-reversal that often happens in caregiving?
Talk it out. Often, people know well in advance that they will end up being the caregiver for an aging parent or spouse, and they are comfortable with it when it eventually happens. In cases (like stroke) where roles can be reversed in a split second, it can take time, and people just have to work through it, talking it out if the cared-for individual is able.
What's the best thing about aging?
The majority of seniors report that they're happy despite health problems that may be present. People adjust their goals and adapt to circumstances as they age.
Things take on different priorities - things that may have caused you stress 20-30-40 years ago may not be as important to you. Seniors' accumulated wisdom allows them to accept that there are things you just can't change.
What's the most important ingredient for healthy aging?
Attitude!! Having meaning and purpose in life (and it doesn't matter what it is that gives your life meaning - it could be stamp-collecting - it's not a value judgment).
The only thing that separates people like Rick Hansen or Terry Fox from the rest of us is their attitude toward life. If you have a good, positive attitude, it can more than compensate for a number of other things that may be lacking.
Is there "ageism" in our society?
Yes, and it's incredibly insidious. It's rooted (like all "isms") in devaluing the aging population - they're past their prime.
You can see ageism in action in things like unemployment rates among seniors and resource allocation (i.e. cutbacks to long-term care facilities, etc.). You can tell society's valuation of a population by the amount of resources that are allocated to its members.
How will the baby boomers differ as seniors from their parents' generation?
They'll be more demanding. They'll feel "entitled." They will have an increased level of awareness about their health, what makes people sick, and know what interventions and medical advances are available to help them.
Where the study of aging is headed...
Those who study aging are struggling to separate what is an inevitable effect of aging from what is avoidable or can be changed. There are memory changes, etc., but many of these effects of aging can be ameliorated.
Top of page

Quality Of Life
When asked, seniors indicate the following as being important to their perceptions of quality of life:
1. Independence: health/well-being; not needing to count on children for things; ability to travel. They don't relish the idea of having to need others for basic functions.
2. Relationships: family; friendships are very important.
3. Money to live reasonably well.
Memory
Do we "lose" our memory as we get older?
A lot of what we call memory "loss" is really just a slowing down of the ability to retrieve material. It's still there, we're just not as quick at accessing it as we used to be.
Verbal fluency may slow down, as does naming (finding names).
There is some debate over whether it is harder for older people to solve new tasks.
Generally, as we get older, we gain a lot of accumulated knowledge, skill and understanding.
What can we do to help keep our memory in top condition?
In general, the analogy is like exercise for the body, but it's not really clear if there is really anything one can do to "tone" memory.
Reading, doing crossword puzzles, and other such activities are good to keep the mind "vigorous."
Culture And Aging
How do different cultures differ in their views on aging?
North American culture places a very high premium on youth.
In contrast, Chinese culture is very reverential and respectful of seniors. They are valued for their knowledge and experience.
The main difference in perception is in each society's valuation of its seniors.
When these values clash, "Old World" parents can be disappointed.
Also, cultures differ in their acceptance of "psychological problems."

Depression
How common is depression among seniors?
It depends on how you define depression. There are two types:
1. the "serious illness" is clinical depression. Approx. 2-5% of those over 65 are affected (not dissimilar to the general population). In nursing homes or hospitals, that population can be affected up to 25%.
2. individual depressive symptoms are much more common. 15-20% of healthy seniors can have one or two symptoms, but that doesn't qualify them for clinical depression.
Previously unaffected seniors can develop "late onset" depression. A person can have been totally fine until a very advanced age, and can then become depressed. Often when this happens there is an underlying medical cause.
Causes Of Depression:
Experts think of causes as being either biological (physical), psychological or social.
Biological: illness is the major physical cause of depression among seniors. For example, depression is really common in the months after a stroke - the combined effects of the "shock to the system" and chemical changes in the brain. Also, some drugs can cause depression, including tranquilizers and beta blockers.
Psychological: losses (trying to cope with the death of a loved one is a common precipitant); changes to lifestyle (retirement); changes to family relationships.
Social: isolation, loneliness, financial difficulties.
There are some seniors who may have had a life history of depression. Those people have an underlying chemical vulnerability to depression, so they may be depressed for no identifiable reason.
Modes Of Presentation:
There are no differences between the way in which men and women present their depression to medical care providers. (Women, as a group, seem more vulnerable to depression, but that may be a reflection of the fact that they tend to outlive men.)
While rates of depression are about equal between the sexes, suicide rates in men are higher because they choose more "effective" means (guns, other weapons) v. women's "gentler" attempts (i.e. pills).
Depression in seniors v. young: seniors don't always present with definite complaints of depression, as opposed to younger people who will often approach doctors saying "I'm depressed."
Seniors may not be as aware that they're depressed. They may feel "something's wrong," but may attribute it to a physical cause - headaches, weakness, lack of energy, constipation. As a result, doctors may just treat the physical complaints.
What To Look For:
Changes in appetite (increase or decrease) or sleep patterns; loss of energy; loss of interest in usual activities; inability to concentrate (suddenly stop reading); they ruminate/feel guilty ("I'm a burden; I feel useless"); they express thoughts of death/suicide ("I don't see the point of going on"); they stop planning for the future.
Treatments Available:
The new generation of anti-depressants (not "brand new," but one generation newer than Prozac) includes Zoloft, Paxil and Effexor.
Often, seniors are given tranquilizers to treat their ailments, when they are really in need of anti-depressant medication.
Psychotherapy: it's really just "talk therapy." Can be individual, group or family.
"Supportive psychotherapy": talking, what's going on with the person, in their life, what's bothering them. Allowing the person to vent. Simple, but important, especially to those individuals who are otherwise isolated.
"Cognitive psychotherapy": people get depressed because they have negative thoughts. Talk to them about their negative thoughts and how they are affecting state of mind.
How Can Caregivers Help?
Encouragement is the big thing. The depressed person doesn't think he/she's going to get better. Depression will go away with time - they need to be encouraged not to give up, and reassured that things will get better.
Do not dismiss the problem.
If possible, mobilize the person. Exercise (even exercises that bedridden people can do in bed) increase endorphin levels.
The Stigma:
People who are seniors today are quite stoic. They lived through the "hard times": the Depression, the World Wars. They consider themselves tough, and it's hard to admit to a perceived weakness.
Problems With Diagnosis:
Some patients who have brain disease (i.e. Parkinson's) are mistakenly diagnosed as depressed. (This happens because of the disease's effect on the facial muscles - the face droops, they don't smile, so they look depressed.)
Conversely, a person with Parkinson's and depression may not be diagnosed as depressed because the facial indicators can be "written off" to the Parkinson's.
Overall it is harder to diagnose depression in a person with any type of brain disease.
Thyroid problems are also commonly misdiagnosed as depression.
An underlying cancer (i.e. pancreatic) can cause symptoms that look like depression.
Misconceptions:
Many people think depression and old age go hand-in-hand. They do not. Many people live to a "ripe old age" in perfect mental health.
Depression in seniors is not inevitable - and if it does happen, it's really very treatable.
Types Of Caregivers:
1. Excessive worriers: They worry obsessively about every little thing and are entirely overprotective of their loved ones.
2. Those in denial: They don't want to see any changes in their parents, so they write-off deterioration or changes as "just part of getting old," when these things are problems that could be dealt with and improved upon with proper treatment.
...and the full continuum that exists between these two extremes...
When To See A Doctor:
Assuming a person isn't grieving over the loss of a loved one or some other such devastating event, if a person exhibits symptoms of depression for more than two weeks, consult their doctor.
It is important, however, that the doctor spend some time (not just 15 minutes; a good hour or so) with the depressed person to allow them to really talk about it.
Most family doctors will start treatment they think appropriate, but if there is no improvement in about 12 weeks, they'll likely refer the patient to a psychiatric specialist.
When To Hospitalize:
When the person "can't function," is in danger physically (i.e. from weight loss), is suicidal, is psychotic (strange thoughts/ideas/delusions), he/she should be hospitalized.

Chapter 1
What is the Myth of Aging?
“The great enemy of the truth is very often not the lie —deliberate, contrived and dishonest — but the myth, persistent, persuasive, and unrealistic. Belief in myths allows the comfort of opinion without the discomfort of thought.” John F. Kennedy
What is Aging?
Before we jump feet first into myth busting, I’d like you to make note that the title of this book is, “The Myth of Aging”, and not, “The Aging Myth,” or, “Aging is a Myth.” Aging is not a myth. Aging is very real, and I don’t discount for a moment that aging, as such, is an inescapable fact of life. Yet there are certain popularly held misconceptions about aging, and I have set about herein to expose perhaps the most insidious myth of all - that as we get older we must also experience the decline of age in preordained ways. First, though, I think some brief attention to what aging is - and is not - is in order.
It doesn’t take a brain scientist to know that aging means getting older. Aging is something that everybody can relate to, because we all age, and because there are certain de facto truths surrounding the myth. Beyond the given, that aging means getting older, we may actually require the services of a brain scientist, and other scientists as well, to determine what it means to ‘age’. Many scientists (and many scientific fields) are not in clear agreement as to what, exactly, the aging process necessarily entails. One reason for this absence of consensus is that people age differently. Another reason is that not all parts of the body age at the same rate or pace, or in the same way. Perhaps the most important reason of all is that much of what is entailed with the aging process is subjective, meaning that to some degree at least, we are just exactly as young or as old as we feel ourselves to be. Much of the pain and stiffness, as well as loss of ease and agility, that people experience as they get older is for all intents and purposes idiopathic, meaning it is due to unspecified origin or cause. Finally, many of those learned minds committed to exploring the phenomenon of human aging do so through the tinted lens of their particular persuasion. Brain scientists look for a neural basis to explain the markers of aging, geneticists for genetic dispositions. Nutritionists may see too many free radicals stemming from diet, while sociologists explore for usefulness and social meaning.
Psychologists may be concerned with the effect on your subjective or objective mind of maturation in the context of growing older. All the while, your family doctor has you watching your cholesterol and blood pressure. What many of you who are reading this passage already know firsthand and without a doubt are the ever narrowing limits imposed on your own bodies by the process of growing older.
What all these scientists are supposed to have in common is that they all take a scientific approach, one in which a full range of possibilities must be explored prior to arriving at conclusions, or so I assumed. Stemming from my interest in Hanna Somatic Education, I also have a vested interest in the neurophysiology of the aging brain, because so much of what happens with the body can be traced back to the brain. In reading much of what has been written about the brain by other leading figures in this field, I found myself frankly struck by the absence of information, or even perspectives, addressing in any substantive fashion the connections between aging brains and aging bodies. Granted, there was ample attention paid to newsworthy degenerative ‘conditions’, recognized pathologies, and traumatic or neuropathological events. But little of what I read even ventured the possibility that there might be more than a casual connection between the physical decline associated with normal everyday aging and the willful brain, and that at least some of the physiological effects of aging might be subject to the brain’s voluntary review. The Myth
Thomas Hanna, in a stroke of genius, nicknamed his core set of movement patterns “The
Myth of Aging” series.1 More than some offhand catch phrase, this label begs a bit of scrutiny as it underscores the very nature of Hanna Somatic Education. A myth is a belief or set of beliefs, often unproven or false, that has accrued around a person, an institution, or a phenomenon, and upon which other beliefs or values may be premised. History, even to the present day, is rife with examples of broad stroke social belief systems premised solely on myth.2 Thomas Hanna saw the currently held beliefs about aging, specifically our collective assumptions about certain of the ‘inevitabilities’ presumed to accompany the aging process, as just exactly that - a myth. In fact, our aging myth has roots dating all the way back to ancient Greece when the fabled Sphinx queried Oedipus thus, “What walks on four legs in the morning, two legs in the afternoon, and three legs in the evening?” The answer of course is man, according to the presumptive decline that necessarily accompanies the aging process, mandating use of a cane in one’s later years.
The particular myth debunked by Hanna is this: As people grow older their bodies inevitably decline along a downward trajectory, usually from middle age onward. This
1 In addition to the 8 movement patterns comprising the Myth of Aging series, Thomas Hanna also composed ten other sets of movement patterns, each containing a series of 6-8 sequential lessons arranged according to body areas or bodily conditions. See Resources in Appendix A to learn more.
2 Examples of such popular or scientific/medical myths can be seen in but a small sampling: 1/The Earth is the center of the universe around which all other celestial bodies orbit. 2/ Cigarette smoking does not pose a health hazard (as recently as the 1980ʼs). 3/ Aliens landed at Roswell, N. Mex . in 1947. 4/ Modern pharmaceutical medicine will eradicate disease by the 21st century. 5/ Neurons in the brain and central nervous system are incapable of repair or regeneration. And finally, 6/ The Red Sox cannot win a World
Series because of the Curse of the Bambino. These are all myths that have been debunked. decline is known to be inevitable because it happens to the great majority of people as they age and move steadily toward death. Because this decline happens to so many people it is the norm. Because it is the norm it is ‘normal’. Therefore, this decline is what each of us must necessarily expect our own future to hold for us. Thus is the myth upon which society’s expectations for itself based. However, the logic of this myth is skewed and, not uncoincidentally, it is decidedly unscientific. Yet, surprisingly, this myth seems to carry with it the full weight and sanction of western science and medicine.
Unimaginable sums of money have been invested in both a mindset and an infrastructure, all premised on the supposed validity of the ‘aging’ myth. Modern conventional science and medicine have hardly a clue that the steady trajectory of human decline, with much of the pain and suffering sadly concomitant to it is, in fact, not inevitable, at least not in a qualitative sense. Much of the attrition and many of the degenerative effects normally attributed to the aging process are avoidable and even reversible.
Of course, common sense dictates that there’s no stopping the chronology of aging. The hours, the days, and the years march on by no matter what we do - we’re born, we live, and, in the end we all die. But the qualitative aspects of how we live our lives and find ourselves impacted by events that occur as we age is unquestionably much more within our realm of control than conventional wisdom would have us believe. Hanna Somatics may or may not have an effect on human longevity, in terms of life extension. Life extension, however, is not our goal. What we seek to achieve is a quality of life, or, to borrow a concept introduced by Dr. Andrew Weil, a ‘compression of morbidity’.3 In other words, Hanna Somatics can help you manage your trajectory of neuromuscular decline as you age to insure that you retain a greater ease and freedom about your body for a longer time than might otherwise be the case by minimizing the effects of insults. Much of the recent research on aging has focused on preservation of mental faculties. But in the words of John Ratey, M.D., a clinical associate professor of psychiatry at Harvard Medical
School, “ ... a sound mind won’t do you much good if your body fails.”4
I see the degenerative aspects of the aging process (at least as regards neuromuscular decline; imbalance, pain, stiffness, etc.) as stemming from little more than the effects of an archeology of insults against the body. It is the cumulative effect of these insults - in incrementally resetting the brain’s default mode for motor behavior to a progressively lower standard of performance and response - that provides the basis for the aging myth.
3 “Healthy Aging - A Lifelong Guide to Your Physical and Spiritual Well-Being,” by Andrew Weil, Dr Weil discusses this concept in the context of his Anti-inflammatory Diet.
4 “Spark...” John J. Ratey, M.D.
The important premise for you to grasp is, as mentioned above, the spectrum of cumulative effects stemming from this archeology of alleged insults. The problem, for most people, derives from layer upon layer of insults incurred over a lifetime of living.
So, what exactly is an ‘insult’? An insult may be thought of as any experience, real or imagined, that (dis)stresses the organism (that’s YOU, your body and your mind).5 For the purpose of Hanna Somatics, our concern is confined to the effects of these insults on the functioning of the sensorimotor/neuromuscular system. Regarding such insults, we can gain some better appreciation of their impact by assigning them, more or less arbitrarily, to one of three levels which I have contrived for ease of understanding.
Insult Upon Insult
The first level involves ‘minor’ insults, which are often benign issues that hardly command, or even warrant, our attention. Examples of ‘first level’ insults might include slumping on the couch while you watch television (or read this book), an emotionally stressful day at work or school, or a sub-optimally nutritious meal. Other possible entries to this list might include; a night of restless sleep, pushing yourself when overtired, carrying a handbag or book bag always over your same shoulder or a wallet always in the same back pocket, parents toting young children about on their hips, or any of a litany of other such low-magnitude experiences falling into the very unscientific category of simply ‘not being good for you’. And these are just samplings of simple direct-cause insults, not even taking into account secondary insults resulting from primary causes, such as when the stress of commuting to work in heavy traffic causes a stiff neck that results in a headache and acute shoulder pain. In sum, these are the kinds of insults that happen to regular people all the time and probably much more often you are likely to be aware of in the absence of your consciously paying attention for them. Quite often these insults, when they happen on an isolated and non-recurring basis, will not contribute in any significant fashion to your eventual decline. For example, a poor night’s sleep can usually be made up for the next night, or your hangover following the annual New Year’s
Eve party will probably not shave years off your life. If ever you incur a stiff neck you may well be able to work out the kinks to no lasting ill effect. But if your stiff neck persists, or recurs on a regular basis, that redefines both the nature, and the effect, of the insult. I repeat, it is the cumulative effect of a multitude of minor insults over time that causes them to become problematic.
Norman Doidge, M.D., in discussing brain plasticity6, describes how neural real estate is allotted on a priority basis according to the demand for its use. “...when we learn a bad
5 To learn more about insults see Chapter 9, ʻHanna Somatics and Childrenʼ, “Insults - How They Occur and How Their Effects Accumulate”.
6 “The Brain That Changes Itself,” Norman Doidge M.D. habit, it takes over a brain map, and each time we repeat it, it claims more control of that map and prevents the use of that space for ‘good’ habits. That is why ‘unlearning’ is often harder than learning...” Though Doidge is specifically referring in his text to the acquisition of language skills he is also describing perfectly the process by which insults against the body culminate as new and errant default settings in the brain, and why, once embedded, the effects of insults can be so challenging to dismantle.
Next, after minor level insults, we move up a notch to ‘medium level’ insults. Medium level insults are rarer than minor insults, yet not at all uncommon. A sampling of this level of insult might include sprains and strains such as a turned ankle or a back spasm, jarring and bruises from sporting or recreational activities or a slip on the ice that bruises your coccyx, an emotional trauma with effects that do not immediately diminish, or repeated challenges on the very limits of your body’s abilities. We all incur medium level insults but, by comparison, these may occur infrequently, perhaps only a few times a year if you’re lucky, rather than many times daily as with lesser insults. Unlike minor issues such as occur on the first level, the effects of medium level insults can linger, either overtly as in the case of a sprained ankle that heals slowly, or less obviously as simmering emotional concerns, or as a back spasm that subsides but remains susceptible to flaring up again when triggered by hidden stress factors.
Notably, minor insults can transform into medium level problems, as when a benign act like toting a handbag or a child shifts from an occasional experience to part of a regular or daily pattern, or when that stiff neck doesn’t go away. Dean Juhan describes this propensity in Job’s Body when he asserts, “...locomotor patterns become individualized by one’s unique pattern of experiences...” Regarding the body Juhan notes, “...repeated gestures become postures, and sustained postures become structures.” He adds, regarding the mind, “An oft repeated mental event becomes a tendency, a tendency followed long enough becomes a habit, and a habit exercised long enough becomes a bit of personal identity.”7 The idea that people can become habituated to their actions (and inured to the effects of those actions) was elucidated by William James as long ago as 1890 when he wrote, “A tendency to act only becomes effectively ingrained in us in proportion to the uninterrupted frequency with which the actions actually occur, and the brain ‘grows’ to their use.”8 Thus can issues of minor concern escalate to a level of greater concern.
An unlikely example of how a seemingly innocuous behavior pattern can shift into a medium level insult presented itself in one of my Tai Chi students. This gentleman had the habit of scrunching his neck somewhat forward rather than holding his head properly
7 “Jobʼs Body,” Dean Juhan.
8 “The Principles of Psychology,” Vol. 1, William James. erect (clearly a medium level insult), and as a result had been struggling for months to integrate my advice during Tai Chi practice that he position his head and neck in a more anatomically correct manner. It dawned on him one day, just as our class was finishing up a round of Somatics movement patterns, that his bifocal glasses were implicated in his postural discrepancy. Apparently, his glasses had caused him to adopt the habit of scrunching his neck whenever he sought to focus his vision, which, of course, he did repeatedly throughout the day. Thus, his glasses not only created a minor insult, initially, but over time they served to reinforce and exacerbate the errant pattern that resulted, and even to stymie his best attempts at correcting it.
Finally, we have a level of ‘major insults’. This more severe level might be comprised of badly broken bones, major surgeries, automobile accidents, stress caused by failed marriages or ruined careers, strokes, etc. These can be hurts that not only last, but which serve to redefine our sense of personal identity. Insults such as these may only occur once every five or ten years or so (again, a generalized assumption offered just for the sake of illustration). Despite their infrequent occurrence for most people, the effects of major insults can be devastating.
It All Adds Up
Obviously, different individuals will be more or less susceptible, or fortunate, in the nature and frequency of the insults they incur. Someone with a more sedentary lifestyle, say a writer, may be more inclined toward low level insults, while a construction worker or sports enthusiast may be more prone toward medium level bumps and bruises. Riskier lifestyles, obviously, entail more risk, but medium to severe level insults are often unpredictable in form and fashion and can hit anyone any time. Just as obviously, people will vary in their response to, and resilience against, various insults and stressors. That said, let’s consider some purely hypothetical statistics, so that you might reflect on the numbers of minor, medium level, and major insults someone experiences, en toto, over the course of a typical lifetime. Minor insults probably occur dozens of times each day for most people. For the sake of argument allow me to (very conservatively) estimate three insults per day. Over the course of a year that adds up to a thousand insults. Add in a couple of medium level insults each year, and over the course of a decade you’ve got ten thousand minor insults, plus several dozen medium level insults, and maybe some really major event as well. Remember, this is your body we’re talking about. Multiply these figures by five or six or seven decades, if you happen to be middle aged or older, and you start to get the picture. The picture you get is that of a person whose body is well advanced beyond the freedom and ease of youth, and stumbling headlong toward the discomfort, inflexibility and systemic decline so characteristic of old age.
I don’t mean to exaggerate this state of affairs, or to promote a general panic. I would reiterate that not every insult has lasting or equal consequences, and that the body has remarkable regenerative powers in its ability to self repair in many cases. Nevertheless, I feel quite confident that I’ve been extremely conservative in understating the figures cited above. Even if we were to arbitrarily reduce these figures further, say by 50%, we’re still talking about tens of thousands of insults against your body over the course of a few decades. That’s a lot of insults! The average body responds to the onslaught painted above with adaptation and resilience where it can, but eventually the weight of this archeology comes to bear on your body in the form of pathological reflex patterns evidencing senile degeneration and decline.
As if all this weren’t cause enough for concern, physiologic decline carries with it the likelihood of reduced self efficacy. The damage wrought by the embodied Myth of Aging is insidious in its effects on our non-physiologic selves as well. As the body comes gradually (or not so gradually) to experience less and less freedom in the manner in which it expresses itself, our belief system about ourselves becomes correspondingly limited. That is, our self image, in its own best attempt to maintain some sense of personal congruity, readjusts to reflect (and thereby reinforce) the experience we have of our bodies. Bodies that become less able to move freely invite the mindsets they house to become correspondingly constrained, thus becoming invested in that loss of ability. “I’m not as young as I used to be.”, “I guess I’m just getting older.”, and, “You can’t teach an old dog new tricks.”, are all-too-common statements of belief that reflect and reinforce the Myth of Aging. We observe our diminishing freedom and so come to think that we can’t be as free, and that this must be what it’s like to be getting old, and thus we fulfill the prophesy.
If I’ve painted a grim picture, it is one that is both realistic and long overdue. The obvious questions to be drawn from the above scenario are, “How can this happen in our age of modern technology?”, and “Why doesn’t science or medicine point their spotlight on this to fix it?”, and on a more personal level, “How can this happen to me?” After all, these days science has us getting upwards of 40 mpgs on many cars, technology has us getting stock quotes and movies on our cellphones, and medicine has created immunizations for even benign childhood diseases such as chickenpox. In light of these and other
‘advances’ one would think that the issue of addressing debilitating insults in order to alleviate the full sweep of human pain and suffering ‘caused’ by aging ought to be both a breeze and something of a priority, at least on the order of chicken pox, gas mileage, and personal finance.
The answer, though complicated because aging is now big business getting bigger, is most simply explained by the fact that nearly everybody buys into The Myth. We’ve all been indoctrinated to expect that aging culminates in a predictable decline. How can you, as an individual, go against the tide and change the inevitable? Our culture is heavily invested, both economically and belief system-wise, in services (Medicare, Medicaid) and products (pharmaceuticals, retirement facilities, etc.) that target pain and chronic disease - arthritis, back pain, headaches, digestive disturbances, respiratory ailments, hypertension, cardiovascular issues, allergies, erectile dysfunction, ad nauseum. One need only glance at the various visual media - magazines, newspapers, TV - to get a sense of how pervasive this mindset is. If you have health insurance with pharmaceutical coverage you are already, inadvertently, subsidizing this very state of affairs. Scientific and medical entities that are capital based, not to mention insurance firms, have a big stake in this status quo. Imagine if it could be shown that even a moderate percentage of erectile dysfunction sufferers could find some measure of relief in a few simple movement patterns. Ask yourself this - wouldn’t Pfizer and Lilly just love to pull Viagra and Cialis
(replete with their ‘afterthought warnings’ about priapism) from the shelves while spending tens of millions of dollars to research simple exercise patterns that cannot be patented, bottled, and sold? Or, in the same vein, what if it could be shown that headaches could be avoided or managed in a similarly simple fashion, obviating the need for the smorgasbord of headache remedies whose marketing campaigns compete incessantly for your attention (so much so as to cause you a headache)?
Conventional medicine, which prides itself on being scientific, has been anything but scientific in identifying and addressing the underlying causes of age-related neuromuscular degeneration. Medical professionals and scientists alike have long been as presumptuous about the degenerative effects of aging on the body as has the general populace. However, in all fairness to conventional medicine, the ultimate responsibility for avoiding or correcting problems stemming from the archeology of insults lies not with the government, or with any other agency, but with each and every individual person.
Herein we have a large part of the appeal of Hanna Somatic Education. In addition to its efficacy, HSE can be learned (or experienced) quickly and easily, not to mention relatively cheaply, by anybody. Thomas Hanna offered up a solution which is so simple and widely accessible that one would expect the claims made by Hanna and those who ascribe to his approach to arouse the passions of skeptics and quack-busters everywhere.
The plain fact of the matter, however, is that Hanna Somatic Education has its basis in simple, yet indisputable, science. All of the theories on which Hanna Somatics is based are founded in conventional neurophysiology, and its claims, albeit empirical at this writing, are predictably replicable. Despite the hint of mystique suggested by such catch phrases as the “myth of aging” and the “archeology of insults” there is nothing about
Hanna Somatics that is even remotely faith-based or new-agey, however low-tech it may be. Continuing advances in the neurosciences only serve to reinforce the most basic premises of Hanna Somatics.
The passage of time is unavoidable, and ‘insults’ such as we have discussed are, for all practical purposes, part of the human condition. Yet Hanna Somatics provides us some measure of recourse. The goal of Hanna Somatics is to help people learn how to exercise and assert their cortical brain’s conscious control over their body’s neuromuscular system, and to disarm and dismantle the effects of the archeology of insults responsible for one’s decline in neuromuscular efficiency (including pain, stiffness, postural imbalances, etc.). Hanna Somatic Education accomplishes this task, in essence, by recruiting the conscious and voluntary attention of the cortical brain to recalibrate the errant default settings of the sub-cortical brain. Such recalibration serves to restore optimal communication, via the sensorimotor nerve pathways, with chronically engaged muscles so that they may finally stand down and relax. Thus is fuller and more efficient voluntary control over the body’s neuromuscular system restored, and with it a renewed quality of life for a happier and healthier you

Healthy Aging IS a Contradiction In Terms

There is no such thing as "healthy aging" - it's a misnomer, a myth put out by the lie down and die school of acceptance and suffering. Sadly, at the present time your only choices lie in how rapidly you allow yourself to degenerate due to age-related biochemical and cellular damage - but degenerate you will, no matter which of the presently available tools and techniques you use.
While health articles like this recent one in Forbes are good insofar as they go, they don't go very far at all. Far too much of the mainstream discussion of aging and health presents only steps one and two of healthy healthy life extension - basically good health practices and common sense - as the be-all and end-all of what can be done. This is far from true; in this age of ongoing biomedical revolution, the dominant contribution to the next thirty years of your health and longevity will come from the medical research pipeline. The future of that pipeline is entirely in our hands - the most important health choice most of us can make today is whether or not to materially support scientific anti-aging and longevity research.
Do you want to see a future in which all the diseases of aging, and indeed any ill-health resulting from aging has been banished? Do you want your future to be one in which "healthy aging" is not a contradiction in terms? If you don't stand up to say so, then this future is that much less likely to arrive within your lifetime.

Myths and Realities of Aging 1
Carolyn S. Wilken2

Overview

Americans view aging as a dreaded time of life. When we think about aging we focus on poor health. We worry about running out of money. We fear loneliness and death. We see birthdays as something to dread, not celebrate. We worry about being >over the hill= or >old and senile=. We turn down job applicants who are >too old=. And we scoff at older adults who are >in love=.
The negative beliefs and stereotypes we have about older adults are a form of prejudice called ageism. Ageism is very common in America. Like other forms of prejudice, ageism hurts both individuals and society. Ageism prevents people from reaching, or maintaining their full potential.
This fact sheet describes some of the prejudices our society has about aging. Ten of the most common myths of aging are explored. A description of what is really true follows each myth.
Myth #1 Senility is a Normal Part of Aging
Getting a little forgetful is a normal part of aging. It is normal to forget to stop for milk at the store, or to forget someone’s name. It is not normal to become so forgetful that it is impossible to manage the tasks of everyday life.
Senility, or dementia as it is more commonly called today is a severe form of memory loss. It is not normal. There are a variety of causes of dementia. Some dementias are more severe than others. Some can even be reversed. Malnutrition, depression, dehydration, and drug interactions can all lead to dementia. Depression can be treated with talk therapy or medication, and the dementia from depression may be reversed. Once the person receives proper nutrition and or adequate liquids, the dementia may lift. Physicians should always be informed of all medications a person is taking to avoid the dementia that can result from bad combinations of drugs.
More severe and long-term forms of dementia are caused by diseases such as Parkinson’s, Creutzfeldt Jakobs, strokes, or brain injuries. Alzheimer’s disease is the most common kind of dementia and causes severe memory loss and confusion.
Alzheimer’s disease creates physical changes in the brain that lead to severe dementia. People with Alzheimer’s disease eventually fail to recognize their own family members. They even fail to recognize themselves. There is no cure for Alzheimer’s disease and the cause is still unknown. But, Alzheimer’s is not a normal part of aging. Researchers estimate that about 4 million older adults have Alzheimer’s disease. That means that 31 million older adults do not have Alzheimer’s disease. It is true that the risk of developing Alzheimer’s increases with age. Nearly
The Institute of Food and Agricultural Sciences is an equal opportunity/affirmative action employer authorized to provide research, educational information and other services only to individuals and institutions that function without regard to race, color, sex, age, handicap or national origin. For information on obtaining other extension publications, contact your county Cooperative Extension Service office. Florida Cooperative Extension Service/Institute of Food and Agricultural Sciences/University of Florida/Christine Taylor Waddill, Dean. Myths and Realities of Aging page 2 one in three people over the age of 85 is a victim of Alzheimer’s disease. Becoming old and senile is a myth. Alzheimer’s is not a normal part of aging.
Myth #2 Most old people are alone and lonely.
This is not true at all! Friends and family are very important in the lives of older adults. In fact, the number of close friends remains relatively stable throughout life. It’s true, the number of casual friends may decrease, but the number of close friends stays the same. People who have many close friends throughout life continue to have many close friends as they age. Those who have only a small circle of friendships earlier in life, keep a small circle of friends later on.
Families remain close even in the later years. In fact, 80% of parents over the age of 65 see at least one of their adult children every 1 to 2 weeks. More than half of older parents have seen an adult child within the past 24 hours. Over 50% of all older adults live within a 10-minute drive of one or more of their grown children.
Grandparents also have frequent interactions with their grandchildren. Grandparent-grandchildren contacts are often centered on a special event such as attending a birthday party or school activity. Three out of four grandparents see their grandchildren at least every week or two. Half see their grandchildren every few days.
Myth #3: Most old people are in poor health.
Another myth of aging is that being old means being sick. Yes, physical changes occur with age. Thinning hair and sagging skin are normal physical changes that happen with age. Older adults have a higher risk of developing certain diseases. Arthritis, heart disease, osteoporosis, diabetes, and cancer are more common among older adults than younger people. But even when they have one of those diseases, older adults make changes in their lives so they can remain independent.
In general, older people describe themselves as pretty healthy. More than two-thirds of people over 65 years of age told researchers that they are in good, very good, or excellent health. More than half of those over 85 years of age said that they are in good, very good, or excellent health
Myth #4: Old people are more likely to be victims of crime.
The notion that older people are “prisoners in their own homes” because they are afraid of crime is a great exaggeration.
In fact, older adults are less likely than younger people to be robbed, assaulted, or raped. In spite of this reality, older adults are more fearful of crime. There are good reasons to be afraid. Crime is a serious problem in many neighborhoods. In those neighborhoods, everyone is at risk, not just older people.
Many older adults are afraid because they live alone in urban or inner city neighborhoods or are alone out on the farm or ranch. Older adults fear they could not defend themselves because they are not as strong as an attacker might be. They are afraid that they cannot run fast enough to get away safely.
The truth is that older adults are more at risk of crime at the hands of their family members or care-givers than from strangers. Family members or care-givers may physically abuse or steal from an older adult in their care.
Myth #5: Most older people live in poverty.
In 1959, one in three older adults lived in poverty. That is why the federal government improved Social Security and strengthened the laws protecting private pensions. Medicare, and programs for nutrition, housing, and transportation were also developed in the 1960s to help older Americans. Those programs have been very successful in reducing poverty among the elderly. Today only one in ten older adults lives in poverty.
Myth #6: Elders become more religious with age.
Not true. The Lifetime Stability Theory predicts that people generally remain the same throughout their lives. This simply means that if someone is religious during their early adulthood, they will most likely be religious as older adults. They didn’t Myths and Realities of Aging page 3 more religious just because they got older. They were always religious. The same applies to those who are not religious. People who are not committed to religious practices throughout their lives are not likely to become involved in religious activities simply because they are older. Research has found a slight decrease in organized religious activities among older adults who were actively involved in their religion in their younger years. Older adults may be less involved in religious activities because of transportation problems such as difficulty driving at night. They may also have problems getting into places of worship because of stairs. When they are not able to attend and participate in religious activities, older adults find other ways to worship. They spend more time reading, watching religious programs on television or listening to religious programs on the radio.
Myth #7: Older workers are less productive than younger workers.
Employers know that this is simply not true. Nearly half of all American businesses employ retired workers. Older employees produce high quality work. They draw on years of experience to solve problems. Older workers are known to be highly motivated, are flexible about work schedules, and have low rates of absenteeism. Given the opportunity, older workers are excellent mentors for younger workers.
Myth #8: Retirees suffer decline in health and early death.
Thinking back on how retirement used to be it is easy to understand how this myth got started. In fact, until recent years, this myth was really a fact. Early in the 20th century, life expectancy was about 46 years. In 1900, an American male’s life span included 8 years of education, 32 years of work and just over one year of retirement. Today, with a life span of nearly 74 years, an adult is more like to work a few more year–39 versus 32 years–but can expect to spend nearly 14 years in retirement.
Most of those years are spent in good health. In fact, millions of people retire, take a few months or year off, and then return to the work force. Others, who retire from stressful or dangerous jobs, find retirement a healthy choice. In the early years of the 21st Century, older Americans can look forward to longer lives, more years spent in retirement and better health than ever before.
Myth #9: Most old people have no interest in or capacity for sexual relations.
Just like many other aspects of life, sexual behavior in later life mirrors sexual behaviors in young and middle adulthood. Researchers have found that good health, not age, is the key to sexual relationships throughout life. The way older adults express sexuality may change over the years. In later years, older adults may prefer touching and cuddling to maintain sexual intimacy.
Myth #10: Most old people end up in nursing homes.
This is perhaps one of the greatest untruths about aging. Fears of aging and the media continue to feed this untruth. The reality is that on any given day, only about 5% of older adults are living in a nursing home, or long-term care facility. Nursing homes today are more likely to be rehabilitation centers where people stay to recover from a stroke, heart attack, or fall. In fact, 25% of older adults may temporarily move to a long-term care facility for rehabilitation. They live in the nursing home for a short period of time–from a few days to a few months–and then return home again. Currently, three out of every four Americans will never reside in a nursing home. Older adults remain in their homes, in their communities. Their families and friends, with the help of community services, provide the kinds of support they need to remain at home.