Central  South  Dakota Medical News
THE CLINICAL VIEW
by P.E. Hoffsten, M.D.
10/11/2001

AGING GRACEFULLY

 This morning a friend described having his 35th birthday and lamented that his life was half over. I thought to myself, "poor child". Here he is just a baby and already contemplating old age. In fact, the average age for women is now 78 years. The average for men is 72 years and both of those numbers are increasing. The average age for women in 1900 was 52 years of age. In the past century, that number has increased by 26 years or 50%.

I am struck by the number of times that a person comes to the clinic, describes the number of symptoms such as backaches, abdominal discomfort, bowel disorders, difficulty with urination and then finishes the description with "perhaps I am just getting old". If the truth be known, medical researchers now project the potential age for man at 140 years if the degenerative diseases so rampant in our society can be prevented. The pivotal question is how does one prevent degenerative diseases.

The first rule was taught to me by my uncle many years ago. He was in WWI in the trench warfare in France. He was gassed with chlorine, captured and spent 6 months in a prisoner of war camp. He had severe pneumonia before the antibiotic era.    Somehow, he survived it all and returned to his home in Webster Groves, Missouri at age 22. He was told that because he had such severe lung problems he only had 6 months to live.      He and my aunt decided that they would enjoy those 6 months together and they got married. My uncle predictably died of pneumonia but it was 55 years later at age 77. Even before I went to medical school, he used to tell me that the best way to grow to an old age is to get something wrong when you are young and then take care of yourself the rest of your life. This brings me to Rule #1: "Even if you don't have something wrong at a young age, act as if you do and take care of yourself the rest of your life".

This is where all of "Mother's Rules" apply. Mother's rules include not eating too many green apples, wearing warm clothes when it is cold, getting enough sleep, not drinking too much, not eating too much, getting lots of fresh air, not driving too fast, and all of the other things that mothers tell their children while they are growing up. The concept that mother's rules cease to apply when a child reaches 20 years of age is invalid. Mother's rules work all of your life. They basically have to do with moderation and balance.

The second rule on reaching old age comfortably comes from Winston Churchill at the beginning of WWII when England was in grave danger. In rallying the English people he said, "Never give in, never give in, never, never, never, never". I see many individuals who often face various serious illnesses and crises. Those that seem to do the best with these problems have an attitude. They are willing to apply those abilities that they have to the obstacles and problems that they have and act as though they are going to be successful.

Two examples of this have recently been published in the medical literature.  In the August 15th, 2001 Journal of the Medical Association, appears an article describing the response of frail elderly women, over age 75, to hormone replacement therapy. These women all had advanced osteoporotic disease and were in significant danger of hip fracture. Half of the group agreed to start estrogen replacement therapy in order to improve bone mineral density. After only 9 months of hormone treatment, the bone mineral density had increased quite significantly compared to the woman who did not use the hormone. Even with a disease far advanced, there are treatments and steps that can help.  In a similar study in the Annals of Internal Medicine in August of 2001, it was shown that hormone replacement therapy maintained normal blood pressures in the women who used this treatment. High blood pressure is the leading cause of stroke in our society. It has been well shown that prevention of high blood pressure prevents strokes.  In the past, the "statin" group of drugs have been shown to prevent heart attacks in many large groups. Initially it was said that the elderly already have blood vessel damage and that these drugs would not help the elderly. Nothing could be further from the truth. Studies have now shown that not only do the statin group of drugs prevent heart attacks and strokes in the elderly group, they are even more effective in preventing heart attack and stroke than in the younger age group. In one large study, the statin group of drugs was more effective in preventing heart attack than was bypass surgery even when bypass surgery was recommended for all of the patients.

In today's world, age itself is not so much the enemy as it is the diseases that come from abuse and poor maintenance of our bodies. That abuse and poor maintenance eventually leads to the degenerative diseases that occur. Just as a 1936 Buick can be made to look new again and run very well so can some of the individuals with degenerative diseases if they are willing to take care of themselves, maintain their health, and stop the practices so abusive to the body.  Diabetes can be treated, heart disease can be treated, high blood pressure can be treated, smoking can be stopped, weight control can be instituted, exercise can be started, etc., etc., etc. Contrary to what many people think, it is not too late to start.

In 1952, Dylan Thomas wrote a poem with the following lines: "Do not go gentle into that good night, old age should burn and rave at close of day; rage, rage against the dying of the light".

As a final thought it should be noted that it is not age itself that leads to infirmity and disability. It is the degenerative diseases that take our abilities. Your local clinic can be a major help in preventive medicine and modification of habits to prevent or slow degenerative diseases.