 1 Human Capital Initiative. article
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\1 Human Capital Initiative. article

 Vitality for Life: Psychological Research for Productive Aging

 Preface

The Graying of America: An Aging Revolution In Need of a National Research Agenda  John C. Cavanaugh and Denise C. Park  Co-Chairs  Vitality for Life Committee  A silent revolution is occurring that is literally changing the face of the nation forever. The revolution is aging. The United States is part of a worldwide demographic shift in which the fastest growing segment of the population is not only older adults but specifically those over age 80. The revolution goes by various names (e.g., the “graying” of America is a popular one), but there is total agreement on one thing: it brings with it many serious challenges as well as numerous opportunities. 

Despite the many scientists, writers, and commentators who have been heralding the revolution for several years, the United States has done little to address some of the most mmportant consequences of an aging population. Even in the midst of on-going debate concerning the future of health care, not enough attention is being paid to identifying ways to change behaviors that improve older adults’ health and reduce the cost of care. In the face of rapidly increasing numbers of the oldest old, little has been done to understand psychological functioning in very late adulthood in order to document normal versus abnormal behaviors. Despite the removal of virtually all mandatory retirement rules, virtually nothing has been done to understand the needs of older workers or how to maintain their productivity. Finally, the mental health needs of older adults also have been neglected, in part because of a proclivity to view psychopathology as either part of the normal aging process or as medical disorders.

Developing a Research Agenda

It was in this context that representatives from 24 behavioral science agencies and organizations met on March 21 and 22, 1993, to formulate a national research agenda to address these pressing and urgent needs. This workshop was initiated and sponsored by the American Psychological Society. Other sponsors include the American Psychological Association, the American Association of Retired Persons, the National Institute on Aging, the National Institute of Mental Health, and the National Science Foundation. A drafting committee prepared a detailed outline and initial working document prior to the workshop. Workshop participants provided feedback and additional initiatives, and the revised document was widely circulated for comment and review. 

The workshop participants and subsequent reviewers considered and thoroughly discussed many aspects of aging but recognized the need to articulate clear priorities in order to maximize the likelihood that the plan would be read and adopted by policymakers. Clearly, this strategy meant that many important topics would be omitted. The Vitality for Life document represents the collective judgment and the achievement of consensus of behavioral scientists of many stripes about both basic and applied research priorities in the psychology of aging, an important feat in itself. We believe that the fours areas chosen—health and behavior, functioning of the oldest old, productivity of older workers, and specific issues in mental health and well-being—reflect important social issues for which psychological research can produce solutions that will ultimately improve the quality of people’s lives. 

Research Agenda Already Has Made an Impact Vitality for Life already has been used as a basis for scientific advocacy for research funding in the psychological sciences. A group of psychologists presented the document to Richard J. Hodes, Director of the National Institute on Aging, as well as to several key congressional staffers in October. A total of 24 behavioral science agencies and organizations and divisions have endorsed it. We believe that the document will be a vital resource in continuing efforts to increase funding for behavioral research as well as to refocus behavioral science research priorities in aging. 

We hope that you will read the Vitality for Life carefully and consider how your own work is connected with the priorities identified here. Additionally, we hope you will support not only this initiative but the overall aim of using the Human Capital Initiative in advocacy efforts to increase funding for behavioral science research. We believe the behavioral research espoused in Vitality for Life provides a coherent agenda for how both basic and applied psychological research can enhance the quality of life for older adults. 

Executive Summary: A Call to Arms A silent revolution is occurring that is literally changing the face of the nation forever. The revolution is aging. The United States is part of a worldwide demographic shift in which the fastest growing segment of the population is not only older adults but specifically those over age 80. The revolution goes by various names (e.g., the “graying” of America is a popular one), but there is total agreement on one thing: it brings with it many serious challenges as well as numerous opportunities. 

Despite the many scientists, writers, and commentators who have been heralding the revolution for several years, the United States has done little to address some of the most important consequences of an aging population. Even in the midst of on-going debate concerning the future of health care, not enough attention is being paid to identifying ways to change behaviors that improve older adults’ health and reduce the cost of care. In the face of rapidly increasing numbers of the oldest old, little has been done to understand psychological functioning in very late adulthood in order to document normal versus abnormal behaviors. Despite the removal of virtually all mandatory retirement rules, virtually nothing has been done to understand the needs of older workers or how to maintain their productivity. Finally, the mental health needs of older adults also have been neglected, in part because of a proclivity to view psychopathology as either part of the normal aging process or as medical disorders.


Developing a Research Agenda It was in this context that representatives from 24 behavioral science agencies and organizations met on March 21 and 22, 1993, to formulate a national research agenda to address these pressing and urgent needs. This workshop was initiated and sponsored by the American Psychological Society. Other sponsors include the American Psychological Association, the American Association of Retired Persons, the National Institute on Aging, the National Instituteoof Mental Health, and the National Science Foundation. A drafting committee prepared a detailed outline and initial working document prior to the workshop. Workshop participants provided feedback and additional initiatives, and the revised document was widely circulated for comment and review. 

The workshop participants and subsequent reviewers considered and thoroughly discussed many aspects of aging but recognized the need to articulate clear priorities in order to maximize the likelihood that the plan would be read and adopted by policymakers. Clearly, this strategy meant that many important topics would be omitted. The Vitality for Life document represents the collective judgment and the achievement of consensus of behavioral scientists of many stripes about both basic and applied research priorities in the psychology of aging, an important feat in itself. We believe that the fours areas chosen—health and behavior, functioning of the oldest old, productivity of older workers, and specific issues in mental health and well-being—reflect important social issues for which psychological research can produce solutions that will ultimately improve the quality of people’s lives. 

Research Agenda Already Has Made an Impact Vitality for Life already has been used as a basis for scientific advocacy for research funding in the psychological sciences. A group of psychologists presented the document to Richard J. Hodes, Director of the National Institute on Aging, as well as to several key congressional staffers in October. A total of 24 behavioral science agencies and organizations and divisions have endorsed it. We believe that the document will be a vital resource in continuing efforts to increase funding for behavioral research as well as to refocus behavioral science research priorities in aging. 

We hope that you will read the Vitality for Life carefully and consider how your own work is connected with the priorities identified here. Additionally, we hope you will support not only this initiative but the overall aim of using the Human Capital Initiative in advocacy efforts to increase funding for behavioral science research. We believe the behavioral research espoused in Vitality for Life provides a coherent agenda for how both basic and applied psychological research can enhance the quality of life for older adults. 

Introduction The United States is undergoing a silent revolution: the aging of its population. This revolution requires that we dramatically increase efforts to understand the social and economic impact of this massive demographic change. This document is a call to action: We must make productive aging a national priority. It is imperative that we develop the scientific expertise to cultivate older adults as a national resource to sustain human vitality across the adult life span into old age and ensure quality of life. To do this requires a significant commitment of funds for behavioral research on aging. Investment now in the behavioral science of aging will result in major advances in our ability to address the major individual, social, and economic issues that will confront our society as our population ages. 

Aging is a behavioral issue. The purpose of this document is twofold. First, a strong case can be made that many issues related to aging are behavioral problems that are best addressed within a behavioral research framework. Much of the untapped potential of older adults to maintain sustained vitality and productivity can best be realized through basic behavioral research and behavioral interventions. Second, evidence is presented that psychologists are capable of making important contributions and achieving solutions to the challenges of aging in our society. We must act now to make the challenges and problems of our aging society a national priority by directing substaniially more research dollars towards the agenda outlined here. It makes sound fiscal sense to act now rather than to react later. 

The numbers are clear—the population of aged adults is increasing more rapidly than ever before. The proportion of adults in the United States over age 65 is the largest in history and will continue to grow rapidly over the coming decades. Overall, by the year 2025, it is estimated that 20% of the United States population will be over age 65 compared to the current 12%. The years 2010 to 2030 will see an enormous increase—the numbers of people over age 65 will increase by 73%, while the population under 65 will decrease by 3%! The growth of the population aged 85 and older is even more dramatic, the size of this group is increasing at much higher rates than any other segment of U.S. society.  Aging is marked by gender and ethnic differences. Due largely to longer life expectancies, aging is disproportionately a women’s issue. The vast majority of the oldest old—those over age 80—are women, many of whom are frail and suffer from chronic illness. Ethnic diversity is also an important issue. The number of older ethnic minority adults is increasing more rapidly than for the population as a whole. Throughout this document, we emphasize the need to examine gender and ethnic differences in all aspects of aging. 

The science of psychology offers solutions to key societal problems. Psychologists bring an important perspective to solving social problems by considering individuals in the context of their entire life span rather than only at a certain static point in development. Psychologists view people as members of complex and dynamic social units consisting of multiple generations within families, acquaintances, and friendships, as well as social systems. Psychologists recognize and incorporate differences across individuals, cultures, and generations into their explanations of behavior, and believe that diversity is integral to the human experience. They focus on identifying connections between the physical and the behavioral aspects of the person in ways that explicate these linkages. 

Psychologists have already produced cost-effective and highly successful behavioral solutions to many societal problems of aging. Psychologists already have a century-old tradition of success in solving social problems, built upon a firm foundation of basic research. The challenge is to understand how basic research complements more clinically oriented studies in order to achieve a beneficial balance between the two that is beneficial for older adults. Three simple examples can illustrate how basic research has led to solutions for practical problems associated with aging. 

The first example focuses on basic research on age differences in visual attention. This research led directly to the development of a simple computerized test that can reliably assess older drivers at risk of having an accident, providing the basis for age-fair assessments of at-risk drivers. These tests will increase our ability to identify drivers who may threaten other members of society as well as themselves. Plans also are under way to train at-risk drivers to improve their attentional and visual functioning in order to lower their risk of accidents. 

A second example of success is that we are beginning to understand how to make an early diagnosis of Alzheimer’s disease based on behavioral criteria. Better understanding of basic cognitive processes such as memory and judgment has resulted in screening tests and diagnostic procedures that have improved clinicians’ ability to differentiate treatable disorders (such as depression) from irreversible disorders (such as Alzheimer’s disease) early in the course of the disorder so that appropriate interventions can be implemented in each case.  A third example of success is the behavioral management of incontinence, a problem that can create high levels of stress for family members and patients, often resulting in institutionalization. Basic research on behavioral principles in behavioral management has produced highly effective treatments that work with a wide variety of clients. Today, behavioral intervention is the treatment of choice for this problem. 

To achieve the goal of vitality for life, the following research priorities must be addressed:  1. We must develop an understanding of how to change behaviors which damage health and to maintain behaviors which promote health. This will result in productive aging.  2. We must recognize that we can optimize the psychological functioning of the oldest-old through both basic research and practical interventions. This will minimize costs of frailty and disability.  3. We must begin to understand how to maximize productivity and how to maintain productivity into late adulthood. This will allow us to tap the wealth of older people’s experience, wisdom, and expertise.  4. We must develop better techniques for assessing mental health and appropriately treating mental disorders in older adults. This will provide older adults a better chance to achieve vitality throughout their lives. 


Chapter 1—Priority 1 We must develop an understanding of how to change behaviors which damage health and to maintain behaviors which promote health. This will result in productive aging. 

Both the cost of health care and the number of older adults using this care are increasing rapidly. The percentage of national resources spent on health care services in the United States surpasses all other countries, to a point where health care expenses are threatening our standard of living as a nation if they continue to grow unchecked. Older adults consume the majority of medical services and prescription medications in the United States, so any improvements in cost-effective treatments that are directed toward the older adult population will have a large impact. A high percentage of older adults (86%) suffer from one or more chronic conditions that require ongoing lifetime medical treatment. Much is known about how to decrease risk and morbidity associated with chronic disease, and the most effective health management often involves a behavior change in diet, exercise, or even coping style. Nevertheless, very little attention has been paid on how to promote behaviors that decrease utilization of medical services and maintain health and productivity into late adulthood. Research on how to promote behaviors that are effective in coping with existing diseases and preventing more illness is needed and would be cost-effective. The psychological research community has both the basic research expertise and the commitment to address this critical research need. 

Problem 1  Although we have increased longevity, we have not necessarily increased the quality of life, particularly in the later years. This stage of life is all too frequently characterized by multiple health problems and frailty. It is important to establish health prevention and promotion behaviors across the life course for sustained vitality and productivity in late adulthood. The prevention of undesirable behaviors such as smoking and excessive eating early in the life course, and the promotion of health behaviors like exercise and good nutrition at any point in life, will enhance successful adaptation during late adulthood.  WHAT WE KNOW. Effective behavioral interventions have been developed to promote health behaviors in older adults. For example, it has been reliably demonstrated that adherence to an exercise regimen improves mental health and a sense of well-being in older adults, as well as providing obvious physical benefits. Interventions on entire communities have been successful in increasing exercise and other health behaviors in older adults. Other researchers have demonstrated that behavioral techniques can be used to increase immunizations for influenza, a disease that can be fatal to an older adult. Computerized telephone reminders have been shown to increase the rate that older adults keep medical appointments, thus enhancing prevention behaviors and using physician time more effectively.  WHAT WE NEED TO KNOW. We need to determine the most effective techniques for promoting permanent change in adaptive health behaviors in older adults. For example, although poor nutrition is believed to be an important factor in frailty and disease vulnerability in elderly adults, little is known about how to enhance nutrition. It is also not known what the most effective target for intervention strategies is. Should interventions occur at the level of the individual, the work force, or even a whole community? There is some evidence that some types of interventions are more effective when focused on groups rather than individuals. More work must be done on the psychological conditions under which individuals become motivated to change health behaviors, the role of spouses and support systems in adopting changes, as well as the most effective settings and types of interventions that result in changes. 

Problem 2  Late adulthood, particularly the last years of life, may be characterized by limited choices, pain, and dependence, conditions which psychological research can address more effectively than research based on the medical model of disease. Common problems that can occur in late adulthood include chronic pain; poor sleep habits which contribute to a low quality of life; and increasing dependence on others due to frailty. The best solutions to these problems are often behavioral rather than medical. 

WHAT WE KNOW. Psychological research suggests that one’s psychological state and the perception of control in later life may play a critical role in illness outcome and survival, attesting to the powerful relationship between health and behavior. There is convincing evidence that older adults who are institutionalized against their will are at a much higher risk of death shortly after institutionalization than older adults who chose the institution as the most attractive alternative available to them. Similarly, there is some evidence that individuals who have certain personality characteristics, or who adopt strong belief systems about illness outcomes may enhance their chances for survival from life-threatening illnesses. It has also been demonstrated that biofeedback and other behavioral techniques are effective therapies for pain management. 

WHAT WE NEED TO KNOW. We know very little about the relationships among age, illness, belief systems, and disease outcomes. Although increasing attention is being paid by the popular press to the role of psychological adjustment, coping strategies, and well-being when individuals are faced with life-threatening illness, this remains virtually an unexplored frontier with respect to outcomes in late adulthood. Also, there is strong evidence that people with the same medical symptoms often have very different outcomes. For example, individuals with equally severe joint damage associated with arthritis will have very different experiences of pain and may differ dramatically in the amount of medical intervention required to manage their treatment. We need to understand why this is the case, and learn how to guide and control the subjective experience of pain. Because the understanding of how the individual patient conceptualizes illness is essential for effective treatments, both medical and psychological, we also need to examine the role of gender and ethnicity in the way individuals think about and cope with illness. Finally, we must learn how to provide better health care for frail elders that does not rely solely on medicine and nursing home models. For example, there have been some very successful respite programs where a few beds in a nursing home are set aside for caregiving families to use occasionally. Such programs allow brief, planned stays for older patients and permit many family caregivers to rest, get medical care for themselves, etc. Such programs have been shown to increase caregivers’ satisfaction and may prevent or postpone permanent institutional placement, thereby increasing patients’ quality of life and reducing health care costs. 

Problem 3  Older adults frequently take multiple medications, but they may have more difficulty adhering to a treatment regimen than young adults and they are also more likely to suffer adverse drug reactions, both physical and behavioral. Approximately 34% of older adults take three or more prescription medications. It is not uncommon to encounter older adults with multiple chronic conditions taking eight or more medications simultaneously. Due to age-rllated changes in cognitive processes, as well as greater susceptibility to adverse drug reactions due to slowed clearance of medication, the correct usage of medications represents a serious problem for older people. 

WHAT WE KNOW. The highest rate of medication nonadherence is observed in the oldest-old, the individuals most likely to have multiple chronic conditions. For the first time, accurate measurement of medication adherence is possible through the use of subtle microelectronic devices. Although research has shown that the oldest-old do have the highest rates of nonadherence for a variety of conditions, studies have also indicated that adherence in this group can be raised to the level exhibited by younger adults with the help of external supports. Older adults who received charts that organized complex regimens and who also received medication organizers that partitioned the medications as they were to be taken for each day improved adherence behaviors substantially. Other research has shown that older adults have more trouble comprehending and remembering medication information than young adults, but that redesigning labels and information produces benefits. Also, research by psychopharmacologists has indicated that older adults are hypersensitive to drugs and respond to them in more variable ways than young adults. 

WHAT WE NEED TO KNOW. We need to understand how medication adherence is related to age changes in cognitive function and also to beliefs about illness and disease. Correct usage of medications is a cognitive behavior that is also related to beliefs about disease and illness. We need to understand how declining cognitive function with respect to comprehension and memory can affect the ability to understand a medication regimen as well as the ability to remember to take medications correctly. More research on how to improve adherence is needed in order to increase the effectiveness of treatment and to prevent hospital admissions due to inappropriate use of medications. The role of spouses and others as informal memory aids for declining cognitive function needs to be addressed in this context. Also, we need to understand how belief systems about illness relate to whether older adults take medications, and how to change beliefs that are not congruent with correct adherence. In addition, the relationship between adherence behaviors and perceived well-being needs to be assessed. Finally, behavioral psychopharmacologists need to document the side effects and behavioral deficits produced by various combinations of drugs typically used by older adults, an area that is little understood and where animal models of behavior would be useful. Research aimed at identifying specific side effects of psychoactive drugs and at identifying psychoactive drugs particularly effective for older adults is needed. 

Problem 4  Older adults are frequently confronted with complex decisions regarding medical treatment, advanced directives, or other advice, but little is known about how to present this information to older adults and how decisions are made. Although there are laws governing patients’ rights and what information a patient must be presented before making decisions about medical care, there are no standards to assess how to present this information to older adults or to determine what an individual understands about his/her medical situation. For example, in 1992 the Patient Self-Determination Act was implemented, and it requires that all patients admitted to a hospital or nursing home be presented with information regarding completion of a living will and designation of power of attorney for medical decisions. There is no requirement, however, that hospital personnel assess whether patients understand the information presented. 

WHAT WE KNOW. Recent evidence indicates that older adults are more likely to seek treatment than are younger adults for the same symptoms, suggesting that there are important age-related differences in decisions to seek treatment. Also, there are troubling findings regarding advanced directives where an older adult designates a proxy for medical decisions. When presented with hypothetical situations, patients and their designated decision-maker show low agreement on how the decision-maker should act to continue or to terminate the patient’s life. Thus, these data suggest that some patients might die when they prefer to live and others might live when they prefer to die. 

WHAT WE NEED TO KNOW. At present, little is known about how patients comprehend information about their various medical conditions or about their understanding of the treatment alternatives available to them. Moreover, it is not clear with respect to the Patient Self-Determination Act whether patients are able to understand the materials presented, are distressed by the decision with which they are presented, and how the law has affected the completion of living wills and designation of a durable power of attorney. Little is understood about why patients and families disagree with respect to medical decisions and how this information is communicated inter-generationally. In addition to research on these issues, there is a need to understand how to develop effective materials to facilitate medical decision making for patients with limited education or declining cognition. More concern needs to be shown for how to include cognitively impaired older adults in medical decision processes, drawing upon basic research in cognitive supports. There is also a critical need for understanding the context in which active and passive euthanasia occurs and the development of psychosocial models for understanding the complex reasoning (in patients, families, and physicians) that underlies increasingly strong public sentiment that patients have the right to make choices about euthanasia. These mental models underlie life and death decisions and they need much more attention by behavioral researchers. 

Priority 2

We must recognize that we can optimize the psychological functioning of the oldest-old through both basic research and practical interventions. This will minimize costs of frailty and disability. 

The oldest-old, those aged 80 and older, is the most rapidly growing segment of our society. This growth in the number of adults in the 80 and older category, the majority of whom are women, is perhaps the most dramatic and most problematic aspect of the demographic changes in the United States population. One in four of the oldest-old is in a nursing home. Of the remaining 75% who are not institutionalized, 45% need assistance in the performance of everyday activities. An estimate of 20 to 25% of the oldest-old suffer from Alzheimer's Disease. Moreover, there is convincing scientific evidence that even the healthy, productive members of this age group experience significant levels of decline in their ability to function adequately in everyday activities. First, there are significant declines in cognitive functioning of older adults. Accompanying these cognitive changes are significant decreases in the quality of social support for oldest-old adults because of the decreasing number of family and friends in their social networks. Finally, reduced psychological well-being may accompany the typical losses in this age group: losses in physical health, losses of social companions, and loss of economic security. This reduced functioning leads to greater societal costs, including the costs of long-term care and institutionalization. Moreover, institutionalization in this age group often exacerbates the problems of psychological functioning rather than reducing them. 

Problem 1  While we have learned a great deal about the psychological functioning of the young-old (those between 60 and 75 years of age), there is limited information available on the functioning of the oldest-old (those aged 75 and older). While there has been a great deal of research on the psychological factors involved in everyday functioning of older adults, this research has been limited for the most part to the life-span below the age of 80. Even though the largest proportional growth in our population consists of adults over the age of 80 years, we have devoted little research effort to this portion of the population. 

WHAT WE KNOW. Most research on the basic psychological processes necessary to function effectively have differentiated young adults (20 year olds, for example) from old adults (60 year olds, for example). With young-old adults (ages 60-75), scientific studies have shown that there are age-related changes in learning, memory, and problem solving. Research on other psychological factors, however, such as personality or knowledge-based cognition (e.g., vocabulary), often show little change with aging. The small body of research on the oldest-old suggests the amount of cognitive decline after age 80 in normal older adults has been underestimated because the very old have not typically been included in studies, or they have been included in such small numbers that their contributions to the age effects have been difficult to detect. Because of the reduced social network of the oldest-old, it is likely that there are important changes in the social functioning of this age group. 

WHAT WE NEED TO KNOW. Basic research is critically needed on changes that occur in mental abilities during late adulthood with specific comparisons between young-old and old-old persons. These abilities include learning, attention, perception, memory, and problem-solving which can be assessed with behavioral methods as well as with biologically based psychophysiological techniques. If we have a better understanding of differences between the young-old and the old-old, we can begin to determine how to optimize functioning in late life, building on the skills and abilities that are least changed with very advanced age. How different are the oldest-old from young-old and how effectively do they function on familiar, everyday tasks compared to performance in new situations? There must be systematic study of how interpersonal social relations and personality differ between the young-old and the oldest-old. We also need to understand better the relative influences of environment and genetic factors in shaping the changes associated with aging. We also need to understand why some of the oldest-old adapt successfully to their environment despite substantial psychological and social change and why some do not. Furthermore, once the patterns of psychological change and continuity in the oldest-old are determined, we need to investigate whether this pattern will be replicated with younger groups of adults as they age and become the oldest-old in the 21st century. 

A final area of concern with respect to psychological functioning in the oldest-old is the need for research to develop psychophysiological methods for the study of psychological processes in this group. Highly sophisticated, non-invasive imaging techniques are now available that can be used effectively to relate brain structure and physiology to behavioral outcomes and pathologies in cognition and to other psychological processes. Precise measurement of many psychological processes is possible using psychophysiological methods. The potential to relate the efficiency of these functions to specific brain structures may very well represent the new frontier in psychological aging research, particularly with respect to discriminating pathology from normal function. Identification of neural mechanisms underlying learning and memory will also provide insights into the causes of cognitive decline in late life. The use of animal models of behavioral and psychophysiological change is important to complement studies with humans, since many species age more rapidly than humans enabling the study of aging processes over several generations in a relatively short period of time.


Problem 2  Effective psychological interventions need to be developed that can promote, maintain, and even enhance the functioning of the oldest-old. Because effective psychological functioning is a determinant of the ability of the oldest-old adult to effectively deal with everyday life, interventions that enhance the ability of the oldest-old to function effectively, productively, and independently in their everyday environment are needed. 

WHAT WE KNOW. There are many potential techniques for supporting psychological function in the oldest-old that have been used with younger adults. Environmental design can promote independence through careful attention to supportive devices and environmental arrangements that compensate for declining perceptual, cognitive, and behavioral processes. A more active technique involves actually training older adults to perform better in cognitive tasks. It is well-documented that cognitive training for general abilities can be effective for young-old adults, but little is known about the modifiability of intellectual function in the very old. 

WHAT WE NEED TO KNOW. Interventions to support and even improve psychological functioning in the oldest-old have not received a great deal of attention. Some promising work suggests that well-learned and practiced behaviors may be more resistant to decline than less expert behaviors, explaining how very old adults may function quite well as long as they are relying on highly practiced and familiar behaviors. There is also some evidence that because the retention of knowledge may not show the same age-related decline as other processes, the very old have an aggregate of knowledge and experience from which to draw that might best be characterized as wisdom. More understanding of how this rich knowledge store may compensate for declining processes is needed, in addition to how it can be tapped to benefit society. There is also some evidence that information can be structured in a way that is easy for the very old to understand and process, and there is evidence that various kinds of environmental supports for declining psychological functioning can be effective. Little, however, has been done with respect to translating this knowledge into everyday applications for older adults, an area of research that needs more emphasis. Work in this area should focus on supports to prevent accidents and improve functioning in the daily environment. 

The use of technology may promote and maintain function, much as eyeglasses are a simple prosthetic that improve vision. Inexpensive, programmable devices can be used as reminders for medication-taking, appointment-keeping, and other tasks in the daily routine. There is increasing interest in training older adults to use computer technology to perform basic and necessary activities, such as banking, grocery shopping, filling out health-care forms, and bill paying from the home. Electronic mail technology has untapped potential to serve as an inexpensive social support network for isolated older adults and to provide cognitive stimulation for older adults with similar interests across the country. 

Problem 3  The oldest-old have serious problems maintaining independence and functional capability because of their reduced mobility and ability to drive. A serious consequence of declining perceptual and cognitive function with age is increasing limitations on mobility. Older adults typically characterize driving as the primary source of mobility, so maintenance of driving becomes the primary concern in maintaining independent functioning. As with society in general, finding alternatives for the personal vehicle for transportation is an important issue. 

WHAT WE KNOW. Frequently, older adults voluntarily restrict their driving due to self-perceptions of declining abilities. Given the importance of driving in maintaining independence and facilitating social support in older adults, it is essential that tests be developed that are age-fair and permit the restriction of licensing on the basis of high predictability of accidents rather than age alone. Some research suggests that restrictions in the "useful field of view" (a measure of psychological visual attention) are highly predictive of accidents in all age groups. Moreover, it appears that people can be trained to improve their useful field of view, which holds great promise for training at risk drivers to be more functional on the road. 

WHAT WE NEED TO KNOW. Effective, realistic, and cost-effective driving simulators for older adults must be developed. Currently, researchers of driving behavior often must measure driving ability by simply looking at accident rates. The lack of an appropriate measure of driving ability among older drivers greatly impedes our understanding of the effects of aging processes on driving behavior. Psychosocial models for how older adults restrict and monitor their own driving should be developed. The relationship between mental impairment and driving behavior (which has not been firmly established) must be better understood, and the role of families in supporting and restricting driving should be established. We also need to develop methods for increasing the use of seatbelts in this age group. Finally, more work needs to be done on improving the ability of older adults to read maps, find their way, and use materials that present information about public forms of transportation. It is important to know the conditions under which older adults will use public transportation, to develop training programs that enhance usage and comprehension of information about public transportation, and to develop better transportation signage for the needs of older adults. 

-------------------------------------------- Chapter 3 Priority 3 We must begin to understand how to maximize and maintain productivity into late adulthood. This will allow us to tap the wealth of older people's experience and expertise. 

As our work force ages, we must begin to understand how to use older adults as an important human resource in order to maintain the vitality and productivity of our work force. Earlier this century, retirement lasted a few years prior to death. Today, it may represent as much as a third of one's life. It is clear that changing demographics will profoundly influence decisions to continue working. Indeed, lower birth rates in the latter part of this century may force baby boomers to remain in the work force long after they had expected to retire, due to a limited number of younger workers to support retirees. Given demographic projections, it is imperative that we capitalize on the resources of older workers. Not only would it be difficult for this country to afford to have one third of its adult population out of the work place, it is also a waste of human capital. Despite declines in some functions and in health, middle-aged and older adults frequently perform at high levels in a wide variety of work settings. Psychologists are just beginning to understand how older adults compensate in the work place for cognitive, physical, and health-related decline, and continue to perform effectively. Psychologists are well positioned to address the issue of work and aging and to develop ways to maximize productivity and maintain work behaviors well into old age. 

Problem 1  Older adults' sensory and cognitive capabilities decline with age, and we do not understand how these changes affect performance in the work place. There are compelling data that indicate that with age, both sensory and cognitive functions change. Vision and hearing decline, and we are slower to respond to and process information. At the same time, the literature indicates that our knowledge base not only remains intact with advanced age, it actually continues to grow. Thus, although speed of processing new information may decline in the workplace, old knowledge is retained and new knowledge is added to the system. It is essential that we develop an understanding of how declines in processing speed paired with increases in knowledge affect work in late adulthood. 

WHAT WE KNOW. Despite age-related declines in sensory and cognitive function, older adults perform as well as young adults in their work environment. It is well-documented that little relationship exists between age and performance in the workplace in most professions. At the same time, it is clear that some aspects of work behavior do decline with age. For example, aged architects and engineers take longer to perform spatial transformations than younger architects and engineers, despite the fact that such transformations are a daily aspect of their work behavior. Aged managers show more decline on many tasks but perform at least as efficiently as young managers in an emergency. Older workers take longer to acquire word-processing skills than young adults but do reach a high level of performance. Despite declines in many cognitive behaviors, it does appear that expert, highly practiced behaviors may be resistant to normal age-related decline. Despite this evidence, older workers are still less likely to be selected for training programs, and many employers believe that there is little return on their investment in such efforts. 

WHAT WE NEED TO KNOW. We need to understand the strategies that highly successful older workers use to support their work behaviors despite declining cognitive processes. There are a variety of compensatory strategies that can be used to maintain work performance, and it is also possible that the wealth of knowledge that older adults bring to the workplace offsets the declines in speed of information processing. This issue needs investigation. We also need to understand the optimal conditions for older adults to acquire new job skills and training. Computer software and hardware that is congruent with both the sensory and cognitive capabilities of elderly workers must be designed. Improved workplace design and environmental interventions that enhance older workers' productivity and provide support for performance need to be identified and implemented. Finally, factors that assist older workers in maintaining job-related skills need to be identified. 

Problem 2  Through research we can identify reasons why some older people keep working while others decide to retire. How long people remain in the work force depends on a complex set of issues, including meanings and values derived from work, financial considerations, health, non-work options, and role expectations. The increasing retiree-worker ratios will require rethinking of when, and why, people retire. The near absence of mandatory retirement ages also will force revisions in people's expectations of work in later life. 

WHAT WE KNOW. Both retired and working older adults are satisfied with their situations. Often, older workers are more satisfied with their jobs than are younger workers. Considerable research has also documented the myriad of roles and satisfactions that people derive from work. We know that the availability of sufficient financial assets is a key predictor of voluntary early retirement, and that health is a key predictor of involuntary retirement. Most retirees are satisfied with their situations, and often, highly engaged workers become highly valued volunteers upon retirement. Volunteerism is an increasing trend in older adults. 

WHAT WE NEED TO KNOW. We know very little about what contributes to people's decisions not to retire, or to continue working into late adulthood, particularly when finances do not play a significant role. Ethnic and gender differences in work attitudes and behaviors are of particular interest in these decisions. New roles for retired workers need to be developed that capitalize on their life experience. Little is understood about the effects of decisions to retire early on the individual or the society (in terms of lost expertise). Models for part-time work or for consulting for older adults must be developed and their effects investigated. The contributions to society that older adults make as volunteers must be investigated as should the role of volunteerism in enhancing the quality of life for the older adult. 

Problem 3  The interaction of work roles and family roles shift with age in ways that we do not yet understand. People's work lives and family lives are not independent. Indeed, considerable energy is expended in trying to find balance between the two. Despite the universality of the search for balance, we know very little about how older workers achieve it, whether the balance of energy expended between work and home shifts with age, and how this relates to productivity and job satisfaction. 

WHAT WE KNOW. Older workers are reliable. We know that older workers are among the most reliable of workers and that they report higher job satisfaction than younger adults, although the relationship of this to family roles is unknown. We also know that older workers are frequently placed in the position of caring for a very aged family member at home. It is firmly established that some aspects of dependent care are extremely stressful, and that workers' productivity levels suffer as a result. Properly designed intervention programs and examination of role obligations can serve to lower stress, but more attention needs to be paid to such programs with respect to older workers. 

WHAT WE NEED TO KNOW. The impact of family changes and responsibilities on the  older worker need investigation. The increasingly common scenario of women remaining in the work force after a spouse retires has received little attention. Also, the effect of children leaving home on the interaction of work and family roles is unknown. The impact on worker productivity of older workers caring for very old parents must be identified. 

Chapter 4

We must develop better techniques for assessing mental health and appropriately treating mental disorders in older adults. This will provide older adults a better chance to achieve vitality throughout their lives. 

Mental stress and mental disorders take a significant toll on the health and productive functioning of older adults. An estimated 22% of older adults have a mental disorder, with highest rates being found among older adults in institutional settings, such as nursing homes (typically over 50%). Improved assessment and treatment of psychopathology among older persons could have a significant impact on the quality of life for older persons and on the economic costs associated with care of older adults with mental disorders. Nearly a quarter of hospital costs for older adults are due to treatment of mental health problems. There are many challenges in the treatment of mental disorders of the aged and psychologists can contribute across the broad range of these problems through research on effective assessments and treatment approaches. Equally important, we need to understand the large individual differences among older adults in responding to the stresses and challenges of later life. Why do many older people who experience the risk factors for psychopathology not develop subsequent problems? What is the life course of mental disorders, how does a preexisting mental disorder change with advanced age? 

Problem 1  Although longevity has increased, the quality of life in later years can be characterized by multiple mental health challenges and stresses. It is important to establish mental health promotion across the life course for sustained vitality and productivity in late adulthood. The stresses of later life include changing physical and mental abilities, changing social roles, changing family roles, and changing economic resources. The maintenance of mental health requires active coping by older adults. 

WHAT WE KNOW. The majority of older adults do not have mental disorders. Nevertheless, individual adaptation in later life requires individual initiative in the self-maintenance of mental, physical, and social functioning. In addition to individual efforts, social resources (e.g., family members and friends) can act as buffers and moderators of the stresses of later life. Equally important, there are ethnic and gender differences in coping approaches and coping effectiveness. In short, there is no single way to effectively respond to the normal stresses of later life.


WHAT WE NEED TO KNOW. Although the descriptive literature on effective responses to later life stress has increased during the last decade, there has been relatively little investigation of the effects of organized interventions to support such effective responses. For example, we need to understand the elements of effective coping that can be applied to programmatic interventions for a number of normal, developmental issues of later life: working through life-transition stresses (e.g., retirement, widowhood, etc.); coping with developmental crises; memory training; attacking the loneliness of later life; decision-making skills; and developing new skills. In addition, we need to understand the influence of adaptation across the life course: what is the impact of mid-life responses to stress on adaptation in later life? What are the unique challenges to mental health among the oldest-old (80+), the fastest growing portion of the older age groups? How does the interaction of the physical, mental, social, and economic determinants of positive mental health change in later adulthood, particularly among the oldest old? 

Problem 2  Alzheimer's disease and other forms of dementia continue to be a critical neurobiological disorder of aging. Although dementia is caused by progressive brain disease, the manifestations and consequences of dementia are largely cognitive, behavioral, emotional, and social. About three to four million Americans are affected by permanent, debilitating, and often progressive cognitive and behavioral losses, with 48% of the 85+ age group experiencing this problem. It is expected that the prevalence of this problem will triple within 50 years. Dementia has both emotional and economic costs. The long-term care required by dementia patients is highly stressful for their primary caregivers, who are most frequently family members. Economically, the direct costs frr caring for dementia patients have been estimated to exceed $38 billion per year. 

WHAT WE KNOW. The progression of cognitive dysfunction associated with Alzheimer's disease has been well-documented, and the behavioral and emotional effects of Alzheimer's are beginning to be better described. Through testing techniques developed by neuropsychologists and psychophysiologists, as well as through neuroradiological techniques, we can effectively diagnose different types of dementia, with an improved understanding of the basic mechanisms of cognitive and behavioral decline in these disorders. A significant number of older adults develop cognitive dysfunction that masquerades or is misdiagnosed as dementia (so-called pseudodementia) as a result of problems of over medication, depression, anxiety, or other potentially treatable causes. In such cases of reversible dementia, the older person's rehabilitation potential can be assessed. Some treatment techniques, such as behavior training, can lessen the behavioral, social, and emotional impact of dementia on the individual. 

WHAT WE NEED TO KNOW. It is urgent that better strategies be developed to differentiate various forms of dementia, early stages of dementia, and to differentiate dementia from depression. The goal is to develop an effective and efficient set of assessment strategies and improve diagnostic accuracy. To accomplish this, studies need to be conducted that document relationships among non-invasive psychophysiological, neuropsychological, and behavioral indicators to determine how these relate to one another. Similarly, research on the behavioral psychopharmacology of medications commonly prescribed for older adults can help develop safe and effective medication treatment while avoiding the unwanted side effects (e.g., confusion and disorientation) that are common among older adults. In addition, basic research on the neuropsychological underpinnings of dementia should continue. 

Interventions for dementia are needed on a number of fronts, including therapeutic interventions to assist the recently diagnosed individual in early stages, who may be in great distress, because most research has focused on the family. Appropriate support and interventions for both the individual and the family also must be developed for later stages of the disease. In particular, the non-cognitive mental health aspects of dementia have been understudied, both in terms of basic descriptive research and intervention. Also, little is known about appropriate support interventions for members of different minority ethnic groups who often use established mental health services less frequently than do members of other groups. Different traditions and different understandings regarding dementia may require different intervention techniques to be effective. 

Problem 3  Depression is one of the most common disorders in older adults. Depression is a clinical syndrome that affects older adults in a variety of ways. Nearly 5 million individuals age 65 and over suffer from serious and persistent symptoms of depression, and over 1 million suffer from major depression. In institutions (e.g., nursing homes), a significant number of residents have major depression. Most of the treatment for older adults' depression occurs in the context of a primary care medical practice, with only a small minority of depressed older adults being treated by a mental health practitioner. Thus, depression among older adults often goes undetected and untreated, seriously eroding the quality of life and productivity of older adults. 

WHAT WE KNOW. Well-accepted, standardized methods for evaluating depressive symptoms and disorders in older adults have been developed. In addition, effective treatment approaches for depression have been developed, including both pharmaceutical and psychotherapeutic approaches. 

WHAT WE NEED TO KNOW. The relationship between susceptibility to depression and normal, age-related changes in brain structure and chemistry is poorly understood. Moreover, the possibility exists that depression in older adults is a clinically distinct syndrome from depression in young adults, with somewhat differing causes, courses, and symptoms. This is an area that needs urgent investigation, since it may lead to more effective treatment approaches and an improvement in the diagnosis and identification of older adults who are most likely to benefit from treatment. 

Research is needed to identify the optimal biological and psychological components of therapy for diverse groups of depressed older adults (e.g., those with late-onset depression versus life-long depressive disorder). In addition, adaptations of therapeutic approaches for older adults with various combinations of cognitive, communication, and depressive disorders should be explored. Similarly, clinical trials and observational studies are needed to identify optimal components of therapy for the very old, older adults from minority or underserved communities, institutionalized elderly, and older adults with a combination of physical illness and depression.  Finally, effective training and educational approaches should be explored to improve the ability of primary care physicians to more accurately diagnose and treat depressive symptoms and depressive disorders among older adults. 

Problem 4  Older adults commit suicide at disproportionate rates; although they represent 12.4% of the population, they account for 21% of suicides. Although the right to choose rational suicide nn later life is legitimately debated as a legal and bioethical issue, the majority of suicides completed by older adults occur among those with an identifiable mental disorder that constrains rational, informed, decision-making. 

WHAT WE KNOW. There are substantial variations in the rate of suicide by different gender, age, and ethnic groups, with white males over 80 having the highest rate of completed suicide. Suicide among older adults can be precipitated for many reasons, including reaction to losses of later life, a reaction to chronic or terminal physical illness, or a consequence of an accompanying depression or other mental illness. Primary care physicians are often contacted by older adults prior to suicide (e.g., over 70% of elderly male victims have seen a primary care physician within a month of the suicide); however, primary care physicians often do not recognize the potential risk of suicide among their older patients. The psychological autopsy has become a respected research method to help in understanding the individual suicide. 

WHAT WE NEED TO KNOW. We need to learn how to effectively recognize the differences between those suicides that represent an informed and rational decision by the older adult and those that are the result of an underlying mental disorder. Standardized research protocols for the study of suicide must be developed and databases pooled in order to develop the large-scale studies necessary to understand this problem. By determining profiles of who is at risk, effective long-term prevention strategies can be developed. For example, we need to identify effective methods of training primary care givers, family members, and others in frequent contact with older adults to recognize early risk signs of suicide potential among older adults and to take appropriate action. Expanded research will also permit an understanding of ethnic differences in suicide rates, as well as strategies for effective suicide prevention in different ethnic groups. 

Problem 5  Anxiety disorders are at least as prevalent among older adults as depression, yet they have received less scientific and clinical attention. 

WHAT WE KNOW. Anxiety disorders constrain or severely impair the social functioning of affected older adults. Estimates suggest that 5% of older adults have an anxiety disorder. Effective psychological interventions for anxiety disorders among young adults have been developed, but their efficacy with older adults has not been fully established. 

WHAT WE NEED TO KNOW. It is often difficult to differentiate anxiety disorders from depression among older adults; sensitive assessment techniques need to be developed to accomplish this. Similarly, assessment techniques should be developed to diagnose anxiety disorders that are presented as physical symptoms or cognitive decline, since these types of problems may be viewed as more socially acceptable mechanisms for expressing emotional distress. Little is known about what combination of pharmacological therapies and psychotherapies are most effective for treating anxiety disorders in older adults. Adaptations of successful therapies for younger adults need to be evaluated for the range of anxiety problems experienced by older adults. We also need to document the psychophysiological reflections of brain and heart function, as well as the biochemical mechanisms that accompany the experience of heightened anxiety among normal older adults. 

Problem 6  More than half of older adults who are treated for physical disorders in hospitals, clinics, and nursing homes also have at least one mental health problem that is typically not effectively recognized and treated in such settings. 

WHAT WE KNOW. The most common problems among older outpatients are depression (at least 25%), anxiety (at least 10%), sleep disorders (as much as 50%), and alcohol-related problems (at least 10%). Large numbers of nursing home residents have both mental and physical illness (e.g., from 25-50% are significantly depressed, along with their physical illness). If left untreated, these mental disorders may affect the underlying physical illness, cause substantial mental distress, and increase the costs of care (by reducing the older person's self-care and thus resulting in the need for more intensive staff assistance). 

WHAT WE NEED TO KNOW. The assessment and treatment of this particularly needy population presents a challenge that has been largely unmet. Clinical and epidemiological studies to understand the relationship between mental disorder and chronic physical illness are urgently needed, as are assessment techniques that can be used in hospital, nursing home, and home settings. Models for the combined use of medical and psychological services need to be developed, along with an understanding of barriers to effective service use. Psychological therapies need to be developed and evaluated for use in nursing homes and home settings to effectively serve older adults who have a combination of chronic physical illness and mental illness The optimal combination of behavioral, psychosocial, and biological interventions to effectively serve subcategories of patients with specific combinations of physical and mental disorders needs to be determined. 

Problem 7  Other mental disorders of aging, while less prevalent, are equally damaging to productive aging. 

WHAT WE KNOW. Other disorders are known to adversely influence the economic, social, and functional productivity of older adults. A partial listing of these problems includes: sleep disorders; homelessness; personality disorders; alcohol and substance abuse; chronic mental illness; and polypharmacy. For example, as many as half of the elderly suffer from chronic sleep disturbance, a condition associated with problematic use of sedative medications and increased illness and death. Similarly, homelessness is another challenge for older adults: a disproportionate number of the homeless are over age 50. 

WHAT WE NEED TO KNOW. The effective assessment and treatment of these particularly needy patient populations presents a special challenge that has, thus far, been unmet. Basic and applied research on each problem area is needed. In addition, the relationship between and among these disorders need to be better understood, in order to design effective treatments. Community-based and institutional descriptive, assessment, and treatment studies are needed. Models for the optimal combination of psychological and medical services for these special populations need to be developed and evaluated. 

Closing Statement The time has come to declare behavioral research on aging a major national priority. The country cannot afford to wait until the next century when the surge in the older population will demand that action occur. We must act decisively now. It is clear that psychologists can offer a great deal to increase human productivity and vitality in late adulthood. Psychologists' understanding of issues such as health, work, the oldest-old, and mental disorders strategically places them at the forefront of scientific investigations of aging. It is only by investing in behavioral research on aging that we will we advance our understanding of many aspects of aging and find solutions to behavioral problems faced by older adults in their everyday lives. Investing in the psychology of aging is investing in vitality for life. 

Human Capital Initiative Backgound For the past two and a half years, the psycho-logical science community has been developing a national behavioral science research agenda that illustrates the potential of behavioral science research to address several critical areas of concern to this country. The first stage of the process began in January 1990 when a group of more than 100 individuals representing almost 70 psychological organizations and additional federal agencies gathered in Tucson, Arizona, for what was to be the first of several Behavioral Science Summit meetings. Convened under the sponsorship of the American Psychological Society with partial support from the National Institute of Mental Health (NIMH), the summit conferees unanimously endorsed the development of a research agenda that would help policymakers in federal and other agencies set funding priorities for psychological and related sciences. 

The result of this first stage is the Human Capital Initiative (HCI) document. Published in February 1992, the HCI is designed as a framework for a sustained research effort. It targets six problems facing the nation, communities, and families and describes these issues in terms of psychological research. The six research priority areas are:  Productivity in the workplace (Changing Nature of Work)  Schooling and literacy  The aging society (Vitality for Life) 


\2 aging 
Age Bio vs Real. Realage.com    To be younger: Eat more fruits and vegs. Floss teeth, Exercise. Get a pet. Vit E, Folic acid/calc. Alcohol, Breakfast, humor

Old age  NYT 6/01/99    More people live long than ever before, to be 100+. Those that make it to 90s are healthier than those 50-80. 25% have no dementia, less cancer, 80% are women but the men are healthier 

The decline in old age mortality phenomenon. NYT 6/01/99  More people live long than ever before, to be 100+. Those that make it to 90s are healthier than those 50-80. 25% have no dementia, less cancer, 80% are women but the men are healthier 

"Life is a temporary victory over the causes which induce death." Sylvester Graham, A Lecture on Epidemic Diseases.

Hist of the world is replete with tales of people trying to stave off aging and death. King David wooed young virgins in search of youth. Wealthy people go to private European med ctrs for lamb cell injections. Many people take megadoses of vit E, drink Kombucha tea, use coenzyme Q10 etc, all in the hope of finding the "fountain of youth". The difficulty is to separate fact from myth. 

Researchers know unequivocally that there is no elixir of youth, but are finding out that some of the biological hallmarks of age can be postponed. This can result in increased vitality in later years. 

First a few facts. It would appear that the body reaches peak efficiency at age 30 and then decline in many ways. Using age 30 as reflective of 100% performance, we see the foll at age 55: (a) pumping efficiency of the heart is reduced about 20% (b) kidney function is reduced about 25% (c) maximum breathing capacity declines about 40% and 60% by 75 yrs, (d) metabolism rate goes down about 10%. 

The aver life span has been significantly expanded so that theoretically it is conceivable that a person could live to 140 years, if we are able to deal with the chronic ailments associated with aging: heart disease, cancer, Alzheimer's, stroke etc. By eliminating these chronic ailments, bodies can be healthier and will only end because of unstoppable biological declines. 

Pathologists report that at least 30% of people older than 85 yrs have minor traumas that their bodies would withstand at earlier ages, but now cause death. As mentioned in the above article on respiratory diseases, the immune system looses its ability to effectively deal with new minor infections resulting in death among the elderly, but not among young people. The more youthful your immune system, the more likely you are to become a centenarian, as seen in a study done at the Univ of KY on people between 100-103 yrs of age. 

Interestingly, cancer accounts for 30% of deaths among people 65-69, but only 12% of those over 80. Cancers seem to grow slower, the older one becomes. Heart disease deaths have declined among the 40-60 yr old grp but is increasing among the older group. This would appear to be a function of the efforts by the govt to get people to reduce their risk of heart disease with low-fat diets, stopping smoking, watching their wt and blood pressure levels. It seemed a cost-effective method in dealing with the med costs that were burdening our society. 

Today, 80% of coronary deaths are in the over-65 grp. This grp will soon include a large pop of "baby-boomers" which suggests the need for greater effort to find effective ways to handle coronary attacks in the elderly. Our pop now has a life expectancy at birth of 76 years. In 1900 it was 47 years. According to an article in the Wall Street Jrnl (2/27/97), "If mortality rate had stayed at 1900 levels throughout the century, the US pop would be 139 million in 2000, rather than the expected 276 million The pop would have grown just 72% over the 100 years, rather than the actual 240% it will have grown."

Exercise, while not prolonging life, can retard some of the functional declines that accompany aging, such as the loss of muscle mass, capacity for physical effort, flexibility, endurance, bone strength and efficiency of the heart and lungs. It can also help normalize blood pressure, blood sugar and blood cholesterol levels, as well as ward off depression. Exercise does not improve pulmonary function, but increases the amount of oxygen consumption resulting in the reduction of the workload on the heart.

Yet indications are that adolescents are smoking more, are heavier and are exercising less than their parents. It is estimated that obesity affects more than one-third of the US pop, with prevalence exceeding 40% in blacks and Hispanics. At the same time, 50% of patients are moderately malnourished on admission to a hosp.

It is fairly common to speculate as to what triggered a heart attack in the elderly. Was it any of the known risk factors (heredity, old age, high blood pressure, inact- ivity etc.)? Or are there other factors. 

One such factor is homocysteine, an amino acid, which appears to be implicated in heart disease. Studies, which compared individuals who had heart attacks or strokes with healthy cohort group, found that high homocysteine levels distinguished the two groups. Two longitudinal studies ( a study which follows people who are healthy over a long period of time to determine what happens to them), one in Boston and the other in Norway found that men who were highest in homocysteine levels faced a threefold greater risk of having a heart attack and young women have a higher risk of stroke. 

While genetics may be important, diet also plays an robust role, both as cause and a treatment. We get homocysteine from dried beans and peas, enriched whole grain cereals, nuts, dark green, leafy vegetables and orange juice. You can also supplement your diet with the consumption of folate or folic acid. Jane E. Brody, in her "Personal Health" column ((Feb. 26,1997) states: "Dr. Robert Russell of Tufts estimated that raising folic acid intake to 400 micrograms a day could prevent at least 13,500 deaths from heart attacks each year. Currently, only about 40% of Americans consume that much."

Another fairly common disorder in the elderly is stroke. Yet, 28% of patients with stroke are under 65 years of age, and women account for 40% of the new cases. Blacks in the US have a rate of mortality due to stroke roughly twice that of whites. The US has one of the lowest mortality rates due to stroke and the rate continues to decline, most probably due to changes in life style.

According to a review article in New England Jrnl Of Med (11/23/95) "Hypertension is curr the most consistently powerful predictor of stroke; it is a factor in nearly 70% of strokes. Hypertension promotes stroke by aggravating atherosclerosis in the aortic arch and cervicocerebral arteries; causing arteriosclerosis and lipohylaninosis in the small-diameter, penetrating end arteries of the cerebrum; and contributing to heart disease, of which stroke is a complication." The authors go on further to report that "In elderly patients (more than 60 years of age), antihypertensive therapy has decreased the risk of stroke by a range of 25% - 47%." Again, we point out that physical activity (exercise) reduces the risk factors for cardiovascular disease. We would suggest that everyone needs to increase their physical activity. Surveys indicated that among people 18-74 yrs of age, only 24% reported moderate physical activity and only 14% reported vigorous activity.

Other interesting research going on in Geriatrics, is the role of caloric intake and aging. The results of animal testing indicates that eating fewer calories in a well balanced, nutrient dense diet does wonders for the health and longevity of rodents. (See: Scientific American, Jan 96, "Caloric Restriction and Aging" by R.Weindruch, 46-52.) Weindruch concludes his article with "It may take another 10-20 yrs before scientists have a firm idea of whether caloric restriction can be as beneficial for humans as it clearly is for rats, mice and a variety of other creatures." There are many caveats in his article including lack of knowledge of the effect of low calorie intake on an individuals ability to withstand stress and its effect on fertility in females.

With normal aging, there is a decrease in bone mass, muscle strength and lean body mass and an increase in fat body mass. Physiological and anatomical changes related to aging include increased susceptibility to heat and cold exposure, decreased immune responses to infections, increased falls, and toxicity to medications. These factors place older adults at risk of worsening health and premature death. 

A National Health Interview Survey revealed that 39% of persons over 65 years of age suffered some limitation of activity due to chronic conditions and that 11% were unable to carry out some major activity. Those over 65 also experienced approximately 50% more disability days due to acute conditions than did younger persons. There would appear to be a need to develop standards for a health risk appraisal, which includes not only an assessment of current health status but also an evaluation of risk factors for future health outcomes. (See: Breslow, L. (1997) Development of HRA for the Elderly. Am J of Health Promotion Vol. 11, #5, May.)

In general, women experience compromised life quality while men experience compromised longevity as they age. The latest figures indicate that the current life expectancies for males is 71.4 years, while for females it is 78.3 years. Males have higher mortality from all leading causes of death. Women tend to have more illnesses and lower self-rated health.

As people age, their sense of well being seems tied in with their relations with peers and in particular with friendship. Intimate relationships. In Aging in Society, An Introduction to Social Gerontology, 2nd ed (Bond, Coleman & Peace) Sage, London)

Gender differences in friendship are particularly marked and, over the years, research has increasingly pointed to the value of a special relationship or confidant in adjusting to the stresses and strains of later life. For women especially, this is also a life course issue in that the presence of a confidant or close friend has been found to be important in terms of social support as well as in the maintenance of psychological well-being and mental health. Moreover, rather than fulfilling this need for a confidant within the marriage relationship, women tend to look to other women or an adult child for this kind of support. Men, by contrast, name their wives as their main source of emotional support and the only person that they talk to about personal problems.

Women's friendship are said to be person-oriented, emotionally richer than men, and characterized by emotional support, intimacy, self disclosure and mutual assist. This is conveyed by talk: conversation being a main activitie of female friendship from early childhood onwards. Men's friendships on the other hand, tend to be activity oriented and based on shared experiences. 

Studies showed that among of older people with children, proximity tended to increase with age, with widowhood resulting is a move nearer to children. In a study by Clare Wenger, over half of the parents saw a child at least once a week and this rose to 3/4 of parents over 80. Two percent of parents never saw their children. 

For older people unable to carry out domestic tasks w/o help, relatives were the usual source of help. Research has also confirmed that women are more likely than men to take the main responsibility, as well as to devote long hours to the tasks associated with informal care. 

Early retirement has meant an increase in the amount of time couples can choose to spend with each other, ahead of some of the health changes associated with late old age. There has been a decline of joint residence between elderly parents and their adult children, a change, which gathered momentum from the 1960's onward.

Gender difference in household work may diminish after retirement, with greater participation by husbands in traditionally "female" tasks such as cleaning and shopping. Such participation is defined as "helping" wives and therefore doesn't change the basic division of household chores. Husbands tend to encroach on wives personal time and space and the husband's presence begins to create different forms of domestic work for wives. 

Retirement can bring out the negative aspects of a marriage, especially for women. Women may benefit less from their husband's retirement than do the husbands.

In the US, it is est by 2005 over half of those reaching retirement age will be divorced at least once. Remarriage is more freq at all stages of the life span. Curr one in every three marriages involves remarriage of one partner. The remarriage rate is higher for men than for women of all ages, leading to an increased likelihood of women being alone in future years. Widowhood among women in late life is a high probability event and is the case for women aged 75 yrs or over. eg, 65% of women in this age group are widowed. This reflects both women's greater life expectancy and their tendency to marry men older than themselves. Nearly 1/3 of widows suffers from depression six months foll bereavement. Widowhood contri- butes to lower morale and declines in physical health in the short term, but stability in social functioning.

Eight of the ten leading causes of death among persons 65 years and older were related to chronic diseases, inc diseases of heart, malignant neoplasm, cerebrovascular disease, arteriosclerosis, diabetes, emphysema and nephritis. 80% of persons 65+ have at least one chronic disease. In one US national study, 49% of non-institu- tionalized people aged 60 or older had 2 or 3 of the nine chronic conditions surveyed, 23% had 3 or more and 8% had 4 or more. (See: Guralnik et al. Aging in the 80's: The prevalence of comorbidity and assoc with disability. 

Sleep disturbances increase with age and a variety of factors have been implicated in contributing to this phenomenon. Surveys indicate a correlation between poor sleep and female gender, anxiety, self-rated health, depressive symptoms, use of medication, nocturia, chronic pain and somatic disease. Another factor that disturbs sleep is dementia, the incidence of which is high in nursing homes. 

Nursing home residents show 45%-75% incidence of poor sleep. This high percentage is probably due to a combo of factors, including age related changes; med, psychiatric and primary sleep disorders; drugs, circadian rhythm disturbances and nursing home environment.

Not uncommonly, the sleep-wake cycle of older residents does not coincide with the institutions schedule and therefore, residents are sometimes put in bed before they are ready to go to sleep. 

Pain is the most common complaint among nursing home residents with the most common cause being musculo- skeletal disorders. Pain is often inadequately treated in nursing homes. By providing better analgesia, sleep disturbances might be curtailed.

Nursing homes should try more individualized night-time care practices, such as sides doing hourly rounds and providing care only if the patients are awake, at high risk for pressure sores or still asleep at the third checking. Need to stress the importance of resident sleep to the nurses and aides, emphasizing they should try to be less noisy and use quieter carts. For the agitated patient, they may try "white noise" machines or other gentle sounds, which have been shown to calm people.

Previously, we had written of the problem of decrease in bone mass with aging. Recently, studies have indicated a role for recombinant human growth hormone (rhGH) in increasing the lean body mass in growth-deficient adults. Studies further indicate that low doses of recombinant growth hormone "are able to modify bone composition by increasing lean body mass, increasing lipogenesis, promoting lipolysis in opposition to the action of insulin on adiopocytes and enhancing the anabolic effects mediated by IGF-1 on protein synthesis in muscle mass." By increasing the muscle strength, it produces an improvement in muscle mass and function. It should be noted that this study also indicated that the hormone does not improve bone density, but does effect bone metabolism, influencing bone formation and resorption.

Possible side effects of this hormone include impaired glucose tolerance and reduced insulin sensitivity and increase in triglyceride levels, all factors in increasing morbidity rates in the aged.

From 1960-90 the US pop grew by 30%, whereas the number of persons 65 or older increased 89% and the number 85 years of age increased 232 %. (Current pop report. 65 plus in America. Wash: US Govt Prntng Office; 1993). 

In this series of articles, we have been describing the definable physiological parameters, which differentiate younger from older adults beyond actual age itself. In general, it appears that the process of aging involves a decline in the efficiency of various cells and tissues and systems. The real question is then what precipitates this decline in efficiency and can it be avoided. Memory impairment probably represents the most obvious change occurring both in the so-called physiological aging and in pathological aging.

One of the assumptions in bio is that normal cells can go through only a fixed number of divisions before they die, a process called senescence. The assumption leads to the conclusion that accounts for the aging process. Harry Rubin, Prof of Molecular Bio at UC Berkeley wrote a review article in Mechanism of Aging and Development 1997; 98:1-35. The article entitled Cell aging in vivo and in vitro, shows evidence that cells "accumulate damage over a lifetime [that] results in gradual loss of differentiated function and growth rate". He rejects the notion of an intrinsic limitation of the number of cell divisions. It is the damage to cells over a lifetime that stimulates the effects of aging, which induces a gradual loss of differentiated function of the cells and growth rate. This stress (e.g. biochemical damage) on the cells reduces its capacity to multiply. It is not related to changes in hormonal states, blood flow or other system effects of aging. This is an important distinction for researchers to make in understanding what is aging. Reduce "the stress" and you prolong life.

Dr. Rubin believes that cells enter an altered stage of growth, due to stress, which renders them susceptible to cancer and other types of intrinsic events( caused or initiated by process that originates within the body) that can lead to death. Rubin states:"there is ample evidence for a decrease in stability of the genome with age which would help to account for the exponential increase in cancer with age. This does not rule out an additional need in many cases for multiple mutations to produce a fully autonomous cancer. More likely, both factors, and perhaps others, contribute to the age dependence of cancer incidence." What happens is that cells loss their capacity to control gene expression. It is this slowing down or loss that manifests itself as the aging process. 

There are attempts by the body to deal with this process as result of the stabilizing feature of multcellularity in organs where metabolic cooperation among cells occurs. "Multicellularity also provides the opportunity for continuous selection of the least damage cells." (Rubin). The object then is to reduce the stress on cells to prevent the start of altered growth stages, manifested as aging. 

It would seem that there is something in the architecture of the gene that relates in some way to longevity. Scientists have found that every chromosome has tails (telomeres) at its ends that get shorter as a cell divides. The telemere length is hypothesized to give some indication of how many divisions the cell has already undergone and how many remain before it becomes senescent. Is this the result of "stress" or a natural process? What would happen if we were able to stop this process? Continued cellular growth is seen in cancer where cells seem to be immortal. Is this the result of an abnormal gene product, telomere non-shrinkage, or other factors? Maybe if we understand the biochemistry of aging, we will have some of the answers, producing longer and healthier lives. The next part of this series will look at the healthy older person and what distinguishes that person from the rest of the population. 

As we reviewed the first three parts of this series, it became clear that there are a number of items that we did not make explicit about the aging process. While these statements are known by all, they have vast significance for the process of aging.

First and foremost, is the objective fact that biological aging affects everybody, evidencing itself overtly and covertly at different ages and in different organs and systems depending on a whole series of cascading effects. Secondly, it is a deleterious process, involving the functioning of cells and therefore organs and finally the organism itself. Thirdly, this process is subtle in most cases, usually manifesting itself when the changes become extreme, or not until the system as a whole is stressed. Fourthly, it is not known if the process of aging is a disease or a natural process of the organism i.e. is there a built in general death factor or if all disease is conquered will we achieve immortality.

As we age, the amount of stress required to cause a breakdown in the health of the organism falls. (This axiom is related to a definition of aging cited by Alex Comfort: Aging is characterized by failure to maintain homeostasis under conditions of physical stress, a failure which is associated with a decrease in viability and an increase in vulnerability of the individual.) See part III of this series for discussion of stress factors.

We also know that age-related changes that do occur have a limiting effect on a number of bodily functions. Chngs in the lens of the eye lead to presbyopia; changes in the cochlea of the ear lead to presbyacusis; a reduction in the accuracy of maintaining posture increases the amount of sway in the standing positions etc.

The big research dilemma revolves around distinguishing between changes, which are associated with normal aging and those which are due to external or internal pathological effects. Osteoporosis is a good example of this problem. As every reader must know, this disorder predisposes an individual to bone fractures. It is gen regarded as an age-related disease, particularly severe in post- menopausal women. However, there are also a number of pathological conditions that predispose one to this disorder or are associated with the development of osteoporosis as prolonged immobility, poor nutrition, and excessive alcohol intake or corticosteroid treatment. 

Another prom example of etiology is impairment in body temp control. It is partly assumed to be due to the aging process but it may be made worse by cerebrovascular disease or the dementing process such as Alzheimer's.

Postural hypotension is another problems that have both age-related and pathological sources. What appears to happen in most of the age-related vulnerabilities is that physiological systems decline with age resulting in a shift in the accuracy of the body to control the chemical and cellular environment and thus leaving individuals more prone to diseases of aging. (Again see Part III of this series where we discuss the cumulative effects of stress on cellular div and the process of senescence.)

In fact, if one were to look at the presenting med probs of the elderly, six symptoms would stand out: mental confusion, respiratory probs, incontinence, postural instability and falls, immobility and social breakdown. While they are probs of the elderly, no one has shown pos evidence that they are age-related. It is mainly beyond the age of 75 and more, at 85 years that frailty and the dependence associated with chronic illness becomes apparent. Yet, generally, these changes were going on for many years, at levels below which we are able to detect and associate conclusively with the age-related deterio- ration process. Talks with med personnel suggest that healthy elderly people quite often have lab test results which are slightly abnormal, but are not deemed signifi- cant. There are many chance factors that may account for these "abnormalities", they may be precursors of cell or system age-related changes leading to expression of disease at a much later date. The sooner we ID signs of a disorder, the more likely treatment will be effective.

This leads us to the "health strategy" we suggest for all people: A med checkup should include a full blood work- up, a biochemical profile, an est of serum electrolytes, a urine analysis for protein and sugar, and a baseline cardiogram and chest radiograph. By establishing a measurement baseline, future check-ups will alert you to changes that may be soft signs of deteriorating or degenerative processes. At the same time, the doc/patient relationship should be a collaborative one in which the doc gathers and disseminates info and the patient is active in applying the healing, using knowledge of their needs in synergistic fashion with the info received. In this way the patient is empowered in the most important aspect of life, the patient's health. 

Life expectancy charts indicates an increase of life expectancy throughout the 20th cen. This is assoc with the external improvements in health including the improvement in hygiene and nutrition and the conquest of some infectious diseases by the process of clean water, vaccination, antibiotics and other med treatment. While more can be done with explicit factors of illness, the balance is now fully in the corner of implicit factors including but not limited to a healthy life style.

This should not be construed as shifting the onus of responsibility to the individual. Achievement of health always is a collaborative process involving the individual, treating health professionals, industry and the government. The latter needs to play an important role in monitoring the environment, encouraging research and providing care to individuals in need of service.

Developing a unifying theory of aging is an important goal of the geriatric field. As one reviews the literature on theory of aging, one becomes aware of almost 100 theories which could be broken down to two main categories which tend to be mutually exclusive, but both probably contain parts of a meta-theory. 

The first category relates to pgmmng theories and involves genetic coding, incorporating the concept that progressive expression of the appropriate genes in life leads to the changes of aging and ultimately to death.

The second category, error theories, contend that envir- onmental influences on the organism lead to errors in gene transcription and protein synthesis and that the steady accumulation of these errors are the cause of aging and death. Over time, the organism is exposed to a series of stresses that lead to malfunctioning similar to what occurs in machinery over time, structural stress.

Future parts of this series will discuss theories of aging in detail to give our readers knowledge, the most powerful tool one could have in their armentarium. 
 Harold Rubin, MS, ABD, CRC, Guest Lecturer therubins.com

Feeling in Control Can Prolong Life, Study Shows By REUTERS   Dec 16, 2000 

Older adults who feel that they have control over the role they most value--be it homemaker, provider or volunteer--may live longer than adults who feel less in control, researchers report.

According to findings published in the Dec 00 issue of  Psychology and Aging, people who felt in control of the roles they most value were more likely to report healthy lifestyle habits such as exercising and not smoking. On the other hand, adults who felt that they did not have such control were more likely to be obese, drink alcohol and smoke. They were also more likely to die prematurely, the report indicates.

"When we are able to perform a role well, for example, be a good provider, it gives us a sense of satisfaction and  meaning," lead author Dr. Neal Krause, a psychologist from the Univ of Michigan in Ann Arbor, said in an interview with Reuters Health. He explained that people who feel in control believe they can handle problems that arise and that the plans they make will be realized.

While there is no way to make older people feel in control, it is possible to encourage adults to become fully engaged in the roles they most value, Krause said. For example, the belief that aging is a time of inevit- able decline might lead people to go out of their way to do things for older people, which can undermine their sense of independence and control.

"Active engagement in highly valued roles should promote  feelings of control, and feelings of control are good for one's health and longevity," he added. The study included 884 retired US adults aged 65 and older who ranked eight roles in order of importance.

Like it or not, we're disposable

Background: These guys take no bunk. As acclaimed research scientists in the field of aging and biodemography, Olshansky and Carnes say they are professionally and personally averse to the hope-hawking and miracle serum-selling that surrounds the graying of our nation. The current popular notion that you can shave years off your biological age and reclaim a "real age" by simply flossing your teeth or wearing a seatbelt they find infuriating. 

In their new, co-authored book, "The Quest for Immortality: Science at the Frontiers of Aging," (W.W. Norton, $25.95), Olshansky and Carnes try to deflate the hysteria that has clouded views of aging from ancient Greek mythology to the local health food store today. 

Married with two children, Olshansky , 46, began his career as a demographer and is now a research associate at the Center on Aging at the University of Chicago and a professor in the School of Public Health at the University of Illinois at Chicago. Carnes, 50, is married, and has three children. A former biologist studying aging in animals, Carnes now is a senior research scientist at the Center on Aging/National Opinion Research Center at the University of Chicago. They have been working together for a dozen years and have won the Independent Scientists Award from the National Institute on Aging. The pair recently presented their views at the American Association for the Advancement of Science annual conference. 

Q--So what is a good, sound scientific view? A--Carnes: One of the things science tells you is our bodies are not designed to fail, nor are they designed for extended operation. Things that are common sense like daily exercise, moderate diet and avoiding stress are helpful. If you do these things, they don't have to cost you money but will provide you the health benefits you need.

There is no science to support the claim that aging can be stopped or reversed. Hold on to your purse or your billfold. The impact of the human genome project is that we may be able to affect the rate of aging in the future. But there is speculation about the longevity revolution. Immortality exists for DNA, not its carriers. 

Q--What really is immortality? A--Olshansky: Once DNA acquires the ability to persist forever, the carriers become disposable. Essentially our bodies are designed to last long enough to reproduce. We are pushing the envelope of survival further. There is hype coming out of the science community that all the answers are found in the molecules or genes. But the body is far greater than the sum of its individual parts. The claims of the human genome project are exaggerated. But it will have an impact on disease. 

Q--Are either of you afraid of aging? A--Carnes: I am for sure. I sat through death personally with my mother and father.  A--Olshansky: I have a different angle. I have not gone through that with my parents. I don't have a fear of aging or a fear of death. That is part of the message of the book. If we fear it, we will fall prey to people who think we can eliminate it. 

Q--In your book you offer a race-car analogy about the body. Can you explain it?  A--Olshansky: You don't know whether you have been given a Yugo or a Mercedes. You start out with genes and what you've been given. You decide whether you push the accelerator. You also have the conditions of the race.  A--Carnes: Everyone is born with a longevity fuel tank. Tanks vary in size. You have access to the accelerator as an individual. You can turn the engine off, but once the ignition is turned on, fuel is consumed even at idle. 

Q--What is a healthy view on aging? A--Carnes: The healthy view is that there is something you can do today that can make you feel better. Fitness leads to an improvement in the quality of life.  A--Olshansky: What we know for sure from our work and from others' is that mice have a life span of 1,000 days, dogs have 5,000 days, and we humans have 29,000 days. Recognizing that the duration is limited, and aging is inevitable, focus the attention on enhancing the quality of the days you have. How long you live is less important than how healthy you are along the way. 

--------------------------------------------------------- The reality of aging. Researchers: Like it or not, we're disposable By Michele Weldon May 9, 2001 

Background: These guys take no bunk. As acclaimed research scientists in the field of aging and biodemography, Olshansky and Carnes say they are professionally and personally averse to the hope-hawking and miracle serum-selling that surrounds the graying of our nation. The current popular notion that you can shave years off your biological age and reclaim a "real age" by simply flossing your teeth or wearing a seatbelt they find infuriating. 

In their new, co-authored book, "The Quest for Immortality: Science at the Frontiers of Aging," (W.W. Norton, $25.95), Olshansky and Carnes try to deflate the hysteria that has clouded views of aging from ancient Greek mythology to the local health food store today. 

Married with two children, Olshansky , 46, began his career as a demographer and is now a research associate at the Center on Aging at the University of Chicago and a professor in the School of Public Health at the University of Illinois at Chicago. Carnes, 50, is married, and has three children. A former biologist studying aging in animals, Carnes now is a senior research scientist at the Center on Aging/National Opinion Research Center at the University of Chicago. They have been working together for a dozen years and have won the Independent Scientists Award from the National Institute on Aging. The pair recently presented their views at the American Association for the Advancement of Science annual conference. 

Q--So what is a good, sound scientific view? A--Carnes: One of the things science tells you is our bodies are not designed to fail, nor are they designed for extended operation. Things that are common sense like daily exercise, moderate diet and avoiding stress are helpful. If you do these things, they don't have to cost you money but will provide you the health benefits you need.

There is no science to support the claim that aging can be stopped or reversed. Hold on to your purse or your billfold. The impact of the human genome project is that we may be able to affect the rate of aging in the future. But there is speculation about the longevity revolution. Immortality exists for DNA, not its carriers. 

Q--What really is immortality? A--Olshansky: Once DNA acquires the ability to persist forever, the carriers become disposable. Essentially our bodies are designed to last long enough to reproduce. We are pushing the envelope of survival further. There is hype coming out of the science community that all the answers are found in the molecules or genes. But the body is far greater than the sum of its individual parts. The claims of the human genome project are exaggerated. But it will have an impact on disease. 

Q--Are either of you afraid of aging? A--Carnes: I am for sure. I sat through death personally with my mother and father.  A--Olshansky: I have a different angle. I have not gone through that with my parents. I don't have a fear of aging or a fear of death. That is part of the message of the book. If we fear it, we will fall prey to people who think we can eliminate it. 

Q--In your book you offer a race-car analogy about the body. Can you explain it?  A--Olshansky: You don't know whether you have been given a Yugo or a Mercedes. You start out with genes and what you've been given. You decide whether you push the accelerator. You also have the conditions of the race.  A--Carnes: Everyone is born with a longevity fuel tank. Tanks vary in size. You have access to the accelerator as an individual. You can turn the engine off, but once the ignition is turned on, fuel is consumed even at idle. 

Q--What is a healthy view on aging? A--Carnes: The healthy view is that there is something you can do today that can make you feel better. Fitness leads to an improvement in the quality of life.  A--Olshansky: What we know for sure from our work and from others' is that mice have a life span of 1,000 days, dogs have 5,000 days, and we humans have 29,000 days. Recognizing that the duration is limited, and aging is inevitable, focus the attention on enhancing the quality of the days you have. How long you live is less important than how healthy you are along the way. 

How May Sensory Changes Affect the Everyday Lives of Older People? 

Our awareness of the world occurs through physiological mechanisms that process afferent, sensory information. Like all physiological mechanisms these are subject to detrimental changes as the body ages. It is essential to understand these changes so that we can meet any extra requirements that may ensue. This is increasingly important as the proportion of the population that is elderly steadily rises. Individuals over the age of 65 now account for 16% of the population (OPCS, 1991a). This essay will identify the problems that arise for the elderly and suggest ways they can be managed.

Gustation shows least age-related decrement because, unlike other neural cells, taste receptors have life spans of only a few days and are continually replaced. Salt and sucrose can easily be identified at all ages, but more complex taste stimuli (eg. carrot) cause difficulties for old people, suggesting that olfaction, rather than gustation, might be impaired (Doty et al., 1984). Olfaction shows marked age-related decline with 25% of 65-80 year-olds, and 50% of people over 80, reporting anosmia (Doty et al., 1984). Possible causes include atrophy of the olfactory bulb (Ordy & Brizzee, 1975), decreased volume of the layers of the bulb (Bhatnagar et al., 1987) and a decreased number of olfactory neurons (Hinds & McNelly, 1981).

Taste and smell are important for the sensory and hedonic experience of eating and if they are impaired the physical and social pleasure of eating is degraded. Fortunately, these sensory losses can be largely offset by using flavour enhancers (Schiffman & Warwick, 1989). However, olfaction also has a warning role in the ability to detect "off" foods, smoke or gas. Therefore food manufacturers should provide large, clearly visible "best-before-end" dates and elderly people should have smoke and gas detectors in their homes. The elderly account for nearly a quarter of deaths due to accidental gas poisonings (OPCS, 1991a), hardly surprising since the ability to detect mercaptans (odorants added to natural gas to aid its detection) deteriorates at the age of about 50 (the ability to detect rose odorants remains high even in the nineties: Gilbert & Wysocki, 1987). 

Somatosensory decrements have also been reported. The elderly are less sensitive to temperature and poorer at regulating their own temperature, increasing the risk of hypothermia and frostbite (Fox et al., 1983). People aged over 65 account for 83% of all deaths by hypothermia (OPCS, 1991a) with the social isolation of many old people compounding the problem (Rango, 1985). Therefore it is surprising that the government insists on imposing VAT on fuel. There is also an increase in the thresholds for pain (Ordy & Brizzee, 1975) and touch (Verriollo, 1980) which can cause discomfort by failing to shift position, especially when sleeping. Furthermore the older person will not be as aware of physical disorders so that simple problems progress to advanced stages of complication before medical attention is obtained. Educating elderly people should alert them to these dangers, and they should be encouraged to attend regular medicals. Finally, the vestibular system degenerates leading to an unstable gait, increasing the risk of falling (Ochs et al., 1985). Even small falls are serious, as osteoporosis is more frequent, increasing the risk of fracture. 30% of people aged over 65 fell at least once in the preceding year (Campbell et al., 1981) and 82% of deaths from falls occur in this age group (OPCS, 1991a). Fear of falling can lead to restrictions in physical and social activities, and those who do fall and incur injury may be unable to care for themselves, leading to a dependence on family members or institutionalisation (Bhala et al., 1982). The risk of falling can, however, be reduced, for example not going out when it is icy, gritting pavements, providing priority seating on buses and trains, installing handrails, maintaining pavements to a high standard, providing lifts as well as escalators, and replacing rugs with carpets. 

More obvious sensory deficits, that the majority of old people encounter, are the declines in vision and audition. Changes in the cornea, lens, and muscles affect vision from the age of 35 (Kline & Schieber, 1985) and changes in the retina and nervous system affect vision from the age of 55 (Keunen et al., 1987). The lens becomes inflexible, leading to problems focusing on near objects (presbyopia), and slowly yellows. The retinal ganglion and receptor cells degenerate, and there is also an increased risk of cataracts, the latter affecting about 25% of 70 year-olds (Corso, 1987). 

These changes affect higher level perceptual processing. Visual acuity declines between the ages of 60 and 80 as a smaller pupil and yellower lens reduces the amount of light reaching the retina (Anderson & Palmore, 1974). Impaired depth perception parallels this decline because the older person cannot discriminate detail, and therefore the texture gradient, that is a powerful distance cue. Decreased spatial resolution, temporal resolution, light sensitivity, contrast sensitivity and a smaller visual field are also reported (Fozard, 1990). Older people are slower to process visual information, poorer at tracking moving objects, and have more difficulty extracting particular objects from a complex visual display (Kosnik et al., 1988). Finally the elderly are more susceptible to glare, due to an increasingly opaque lens which scatters light waves as they enter the eye (Carter, 1982).

The reduced visual capability produces poor environmental orientation, decreased mobility, and increased susceptibility to accidents (Hill, 1973). The elderly are 60% more likely to be involved in a road accident than middle-aged people (Planek, 1974), accounting for a quarter of all deaths on the roads (OPCS, 1991a). Although the most important cause of road accidents in the elderly is their slower processing of information, sensory impairments are a significant contributory factor (Planek, 1974). Due to the elderly driver's smaller visual field, they are less aware of cars pulling out of side streets (Jaffe et al., 1986), explaining why older drivers are frequently involved in accidents involving "right of way" violations (Planek, 1974). Old people have problems with dashboard instruments due to difficulty with focusing at near distances (presbyopia), and being slower to change accommodative focus from the instrument panel to the road (Sojourner & Antin, 1990). Night driving is particularly hazardous, since most of the viewing must be done in dim light and, in addition, the lights of oncoming vehicles produce glare (Carter, 1982).

Fortunately the quality of life of the visually-impaired elderly adult can be markedly improved. Cataracts are now operable, the cloudy lens being replaced with a synthetic one and presbyopia can be corrected with spectacles. By the age of 45, 88% of people wear glasses, climbing to 98% by the age of 65 (OPCS, 1991b). Large-print and "talking" books are also available. Large figures should be used for important visual displays, such as traffic signs, clocks, and fire exits, and colour discriminations in the blue-green range (made difficult by the yellow lens) should be avoided (Regnier & Pynoos, 1987). High illumination levels should be used (Kaufman & Haynes, 1981) and buildings should take into account the decreased rate of dark adaptation in the elderly by avoiding sudden shifts in illumination level, especially at places with changes in floor level (Regnier & Pynoos, 1987). Environmental changes can control glare for the elderly, by shielding light sources, using several small low-intensity lights rather than one of high intensity, and using non-reflectant materials on walls, floors and ceilings (Boyce, 1981). Contrast should be optimized at all times, for example, by using white as opposed to grey paper, and ink instead of pencil (Cushman & Crist, 1987).

Turning to audition, 19% of 55 year-olds and 75% of 79 year-olds suffered from some form of hearing loss (Schaie & Geiwitz, 1982). Auditory damage includes sensory presbycusis due to atrophy of the receptor cells, neural presbycusis due to nerve fibre degeneration, mechanical presbycusis due to a decreased elasticity of the basilar membrane and metabolic presbycusis due to atrophy of the stria vascularis. These types of hearing loss preferentially affect high frequency sounds (apart from metabolic presbycusis which affects all frequencies) which are the most important for speech discrimination, and by 80 years-old there is an average decline in speech understanding of 25% (Plomp & Mimpen, 1979). Shouted warnings may be misunderstood or not heard at all, car horns may not be noticed, and ordinary warning sounds, such as breaking glass alerting one to an intruder or screeching brakes, may go unheeded.

Unfortunately, hearing aids are generally a less satisfactory solution to the hearing-impaired adult than spectacles are to the visually-impaired. The best models are expensive, while cheaper ones do not selectively boost high frequencies producing a distracting "booming" effect. There is also a greater stigma associated with wearing a hearing aid, perhaps because presbyopia begins in the thirties, whereas presbycusis does not affect the majority of people until the seventies, and so is taken as indicative of being "over the hill". Supporting this conclusion, while 18% of people over the age of 75 wear hearing aids, a further 25% report severe hearing difficulties yet will not use an aid (OPCS, 1991b). If the elderly individual is to benefit from a hearing aid they must receive considerable encouragement, guidance and instruction and be realistic about the limitations of the instruments, since they do not restore normal hearing. With counselling 60% of elderly hearing aid users can achieve a satisfactory level of social functioning (Jeffers, 1969). The elderly patient should also be taught to lip-read and receive speech training. The latter is required because an individual with presbycusis gradually loses the ability to use auditory feedback to regulate the movements of the articulators (ie. the lips, mouth and tongue).

The acoustic environment can also be altered to maximize the elderly person's remaining auditory abilities. The volume of important sounds should be increased (Regnier & Pynoos, 1987) and warning signals should use low frequency sounds with maximum reverberation, since the physical sensation of vibration may alert the deaf. Background noise can be decreased, for example by avoiding piped music and noisy air conditioning units (Regnier & Pynoos, 1987). Echoes can be reduced by using sound absorbing materials on walls, floors and ceilings (Plomp & Duquesnoy, 1980). Finally, speech should not be too fast since the majority of elderly people cannot follow speech rates faster than 200 words/min.

In conclusion, declining sensory capabilities place the elderly person in a new and restrictive environment. Auditory localisation is less accurate, the defining features of visual objects are blurred, and a once familiar environment becomes confusing, even unrecognisable. Sensory deficits alter a person's social environment affecting their ability to sustain normal interpersonal relations. This can produce feelings of loneliness, insecurity, apathy and indifference. Elderly people with visual and hearing impairments leave their households less often and have fewer social contacts (Birren & Schaie, 1977). Mental competence may decline if the individual begins to avoid interpersonal interactions (Schaie et al.,1964), and emotional lability, paucity of speech and even dementia-like behaviour can result (Maloney, 1987). Some elderly people deny their impairment, while others feel a loss of dignity and identity without adequate environmental contact. This may cause the elderly individual to adopt maladaptive behaviours (Hyams, 1969). For example, deafness is correlated with paranoid psychosis, presumably as the person misinterprets poorly heard conversation as hostile towards them (Cooper et al., 1974). Sensory impairments are also associated with increased risk of depression and decreased self-sufficiency in daily living activities (Carabellese et al., 1993).

Unfortunately the changes discussed in this essay usually occur with other problems, such as infirmities, poverty, widowhood, retirement and an increased dependency on others, thereby straining the individual's personal adjustment. We can alleviate this emotional burden by helping the elderly cope with their sensory impairments. I hope this essay has demonstrated how important, and often how simple it is, to achieve this aim. 

\3 stress

Bypassing Stress Test on Way to Fitness By ERIC NAGOURNEY Urging older people to have stress tests before they begin exercise pgms, a common med practice, is not only unfounded but may even discourage people from getting the physical activity they need, a new study reports.  

The vast majority of older people do not need the test, in which heart function is measured as a patient uses a treadmill, the researchers wrote in a recent issue of The Journal of the AMA. Instead, they said, the patients should simply have complete physical exams.

The lead author of the study, Dr Thomas M.Gill, a prof of internal med and geriatrics at Yale, noted that only about a third of elderly people are considered physically active.

"That's discouraging to us," he said, "because in the past, there has been a wealth of new evidence demonstra- ting the benefits of physical activity and exercise."  The study said a review of the evidence suggested that the risk of heart attack related to exercise might be overstated, and the researchers suggested that the overall benefits of exercise outweighed any risk.

In a 79-year-old woman, vigorous exercise like slow jogging, speed-walking or tennis appeared to raise the annual risk of a heart attack to 1.6% from 1.3%. In a 90-year-old man, the risk rose to 4.8% from 3.9%. Less stressful forms of exercise carry even less risk, the study said.

Under the guidelines of the Amer Heart Assoc and the Amer Coll of Sports Med, doctors are advised to conduct stress tests routinely among older people who want to start exercising. The goal is to detect asymptomatic heart blockages.  But often, Dr. Gill said, older people cannot complete the treadmill test satisfactorily, and so meed more elaborate tests to determine if there is a blockage.

Still, he said, older people who have not been active should begin slowly, with activities like walking and balance exercises.

STRESS-TEST ANALYSIS REVEALS NEW GROUP AT RISK  From Tribune News Services.  Sep 21 2000
  NEW ENGLAND - Apparently healthy men with frequent out-of-sync heartbeats during stress testing run more than twice the usual risk for dying of heart disease or stroke, a study shows.

Such people generally are viewed as healthy. The study shows they  need more evaluation and extended follow-up for any early symptoms  of cardiovascular disease. "Stress tests are being done all over the world and coming up with  these arrhythmias. Until this study came along, no one knew what to  do with them," said Dr. Hugh Calkins, a heart specialist at Johns  Hopkins University in Baltimore. Calkins wrote an accompanying editorial for the study, which appears  Thursday in The New England Journal of Medicine. Treadmill stress tests have been used since the 1960s. Of the group  with frequent irregular beats, 17 percent later died of heart  disease or stroke. Only 7 percent of others died from such disease.  The risk was calculated as 2.5 times greater for the group with  irregular beats.

---------
  TREADMILL RECOVERY TIME CAN PREDICT RISK OF DEATH 
  September 21, 2000 

How quickly a heart beat returns to normal after a common treadmill  test can predict the risk of death in the next few years, a finding  that helps make such tests a powerful tool, researchers have  reported. A look at 9,454 patients at the Cleveland Clinic who underwent  stress tests found that in 20 percent of them the heart rate fell by  12 beats per minute or less in the first minute after the test  ended, which is considered an abnormal recovery rate. Follow-ups for the next five years found the abnormal group was four  times more likely to die from a variety of causes than patients in  the test whose heart rates returned to normal faster. An abnormal heart rate recovery after exercise may signal an  insufficient blood supply to the heart. When those readings are  combined with another score on the test--how long the patient was  able to stay on the treadmill--the results are even more valuable,  said the report in this week's Journal of the American Medical  Association. "Our study suggests that by using heart rate response and treadmill  exercise score, exercise tests can be used as a powerful marker of  risk even in healthy patients," it said. "Patients with intermediate to high-risk treadmill exercise scores  were found to have even higher mortality if abnormal heart rate  recovery was also present," the report said. "Patients with both  low-risk treadmill exercise scores and normal heart rate recovery  had very low risk of death." Together, heart rate recovery and treadmill exercise scores appeared  to be complementary, strengthening the predictive value of exercise  stress testing, it said.

\4 stink

In Sept 99 Shoji Nakamura at Shiseido found out that old people stink because of a substance (noneal) that breaks down fatty acids in the skin. It becomes noticible around age 40 and increases in volume and strength on both men and women. Shiseido then c
reated a successful line of deodorants to curb the stink.


\5 plastic surgery

How Not to Get Skinned!

Where your face is concerned, do not cut corners. It is  critical to choose a qualified practitioner who can assess  what you need. Though skin care is usually the domain of  dermatologists, many plastic surgeons also perform these  procedures. "There is a lot of overlap," said Dr. Alan  Matarasso, a plastic surgeon in Manhattan. Experience is what counts most, Dr. Matarasso said. "The key  is that whoever is evaluating you must be able to distinguish  what needs to be done. So whether it's a dermatologist or a  plastic surgeon, you want someone who will say, `Now wait a  minute, injecting this into that loose skin on your jowl is  going to be like spitting in the ocean.' " To find a good doctor, ask your own doctor for a referral or  call a university-affiliated hospital. Make sure the doctor is  board-certified; dermatologists are accredited by the American  Academy of Dermatology, and plastic surgeons by the American  Society of Plastic Surgeons. Helpful Web sites include the American Academy of Dermatology  at www.aad.org and the American Society of Plastic Surgeons at  www.plasticsurgery.org; both offer a search function for  finding a doctor. -- DONNA WILKINSON 

AST summer, Farley Clark began noticing the signs. "I was starting  to get a few little lines around my mouth and eyes and some frown  lines on my forehead," she said. "But I didn't think I needed a  face- lift yet. I wanted something to perk me up." Looking youthful is important to Ms. Clark, a commercial real estate  broker in Manhattan who gives her age as 50-ish. But any procedure  with a long healing time was out of the question. "In my business  it's important to stay competitive," she said. "I wanted to look  good right away." Ms. Clark consulted Dr. Michele S. Green, a Manhattan dermatologist  who is an attending doctor at Mount Sinai Hospital. She recommended  injections of the muscle relaxant Botox for her crow's-feet and  frown lines, and the wrinkle filler collagen for the lines around  her mouth.  Since receiving her treatments last July, Ms. Clark has become a  convert to the quick fix, returning every few months for a redo. "I  have no side effects," she said. "I walk out and look great."  From fillers to peels to lasers, cosmetic medical techniques today  offer a full range of minimally invasive options that can tame  anything from facial lines to bulging varicose veins. Often referred  to as lunchtime rejuvenation, most techniques can be performed in a  doctor's office in about an hour or less. "The wonderful thing about  many of these procedures is that there's no pain afterward, no  recovery period," Dr. Green said. "When people leave my office,  they're happy." With baby boomers getting older, there has been a sharp rise of  interest in ways to stop the clock. Last year, more than 1.3 million  people had some kind of plastic surgery procedure — a 227 percent  increase from 1992, according to the American Society of Plastic  Surgeons in Arlington, Ill. The use of a nonsurgical treatment like  collagen, for instance, rose 51 percent since 1992.  "There is definitely a trend toward smaller, less invasive  procedures," said Dr. Walter L. Erhardt Jr., the president of the  society. "And there are a number of reasons why — technological and  procedural advances have allowed it to happen, people are more aware  of fitness and wellness, and the economy has allowed people to avail  themselves of these things." Dr. Norman Leaf, a plastic surgeon in Beverly Hills, Calif., and the  director of Solutions Skincare Medical Clinic, added: "This medical  skin-care type of thing is really catching on. It's nice to have  noninvasive aspects and yet it's more intensive than people can get  in a regular salon because it's medical."  Many people are hoping these regular cosmetic medical tuneups may  delay surgery. As Ms. Clark said, "If I can put off going under the  knife, I will probably continue to do this for the next five years —  as long as I like what I see in the mirror." How effective are these treatments? Though many can enhance  appearance, they will not perform miracles. "They will make you look  better on the surface, but they won't tighten a sagging foundation,"  said Dr. Sherrell J. Aston, a Manhattan plastic surgeon and the  chairman of the plastic surgery department at Manhattan Eye, Ear and  Throat Hospital. "A face-lift corrects sagging of the muscles and  skin. So if you're talking about loose skin, Botox isn't going to  help."  Here is a sampling of some techniques:  Preventive Treatment

Botox: Derived from botulinum toxin A, this substance — when  injected in microscopic doses — temporarily freezes the muscle, thus  preventing wrinkles. "Over time it may actually cause atrophy of the  muscle and slow down aging," said Dr. Alan Matarasso, a plastic  surgeon in Manhattan and clinical associate professor of plastic  surgery at Albert Einstein College of Medicine in the Bronx. Purpose: To eliminate lines between the brows, on the forehead and  around the eyes; can also relax cords on the neck. 

Anesthetic: Topical numbing cream.

Recovery: No downtime; effects last three to six months.

Downside: In rare cases, if used improperly in the eyebrow area,  excess Botox has been said to produce some temporary drooping of the  upper lid. 

Cost: About $500 for an area.  •  Soft-Tissue Augmentation

Fillers: Injected below the surface of the skin, liquid fillers can  erase fine lines, wrinkles and depressions in the skin. The most  popular filler is collagen, derived from bovine skin. (Another  common filler is Dermalogen, from human tissue.)

Purpose: To fill in the lines running from nose to mouth and around  the lips; to plump up the lips. 

Anesthetic: Topical numbing cream.

Recovery: No downtime; effects last three to six months.

Downside: May cause mild redness that subsides in a few hours; about  3 percent of the population is allergic to collagen, so be sure to  be tested. 

Cost: $400 to $425 per treatment. •  Peels

Light Chemical Peels: Two popular peels are trichloracetic acid  (TCA) and glycolic acid. TCA is applied in lower strengths (about 10  percent) and glycolic acid (an alpha-hydroxy acid, the ingredient found in many over-the-counter products) in higher strengths. "The lighter peels, like TCA, are exceptionally good for lines around the mouth," Dr. Leaf said. 

Purpose: To exfoliate the skin, promote cell rejuvenation and give the skin a glow; can be used on the face, hands, neck, chest. 

Recovery: No downtime.

Downside: May leave some mild redness that subsides in a few hours; may cause mild irritation, dryness and sensitivity to sunlight; and may affect pigment. (People with dark skin should be cautious about getting peels.)

Cost: $125 to $225 a peel; six treatments, one every other week, are recommended.

Microdermabrasion: Similar to polishing, this treatment uses a mechanical device to spray an abrasive — aluminum oxide crystals that sands the skin's outer layer. 

Purpose: To exfoliate and give the skin a glow. Recovery: No downtime.  Downside: May leave mild redness. Cost: $175 to $200; a series of treatments may be recommended. 

Lasers Nonablative laser treatment: Also called laser toning, this proc uses a combination of minimally invasive lasers like the Nd/YAG and diode — to encourage the growth of new collagen. "We try to stimulate collagen within the skin's dermis, the deeper layer of the skin," said Dr Roy Geronemus, a dermatologist and the dir of the Laser and Skin Surgery Center of NY, who helped develop the technique. "This seems to have a beneficial effect on the skin's tone." 

Purpose: To improve tone and eliminate fine lines and some types of acne scars; can be used on the face, chest, neck, hands. 

Anesthetic: Topical or none. Recovery: No downtime. Downside: May leave mild redness or swelling that subsides in a few hours.

Cost: $400 to $600 (four to six follow-up treatments are recommended).

Endovascular laser treatment: This painless new technique to eliminate varicose veins, pioneered by Dr Robert Min, the dir of Cornell Vascular and an asst prof of radiology at the Weill Medical College of Cornell in NYC, uses a laser to seal off the saphenous vein from the inside.

(The saphenous vein runs from the inner groin to the ankle and is the underlying cause of varicose veins; when it malfunctions, it causes blood to run down instead of up toward the heart, which results in pooling in the blood vessel.) Laser fiber is inserted behind the knee into the saphenous vein, then passed up to the groin, where the vein is sealed with a laser. Closing off the vein causes it to shrink, making the bulging veins disappear. "We seal the vein shut and take care of the leak," Dr Min said.

Purpose: To eliminate varicose veins.  Anesthetic: Local. Recovery: Normal activities can be resumed immediately, but patients must wear support hose for a week.

Downside: There may be tenderness along the vein and bruising for about 7-10 days. About 500 people have been treated, and few side effects have been reported. But even with the procedure, Dr Min said, varicose veins can return. "If you have a hereditary predisposition toward varicose veins, we can't get rid of that." 

Cost: About $2000 a leg; $250 to $500 for follow-up visits to correct smaller veins.

Note: Closure, a similar procedure, uses radiowaves to close the saphenous vein. 

Banish Wrinkles in an Hour! (For a While, Anyway) By DONNA WILKINSON  Jun 24 2001 


\6 Acupuncture

Acupuncture is an old system of treatment. A part of the discipline of traditional Chinese medicine. This embraces many other forms of healing, quite apart from acupunc-ture, as Chinese herbal medicine. Acupuncture is not, nor has it ever been, a complete system of medicine in its own right. It is, however, effective in conditions which have often not responded to conventional approaches.

Acupunture's main use is intreating chronic and painful conditions such as arthritis, headaches and migraines. After dental caries (tooth decay) and the common cold, these are the most common afflictions of the human race.

Its effectiveness has enabled acupuncture to survive against, at times, enormous odds. It was banned by law in China at the beginning of this century but continued to be practiced as folk medicine. Interest by Western doctors in acupuncture was stimulated by Nixon's visit to China in 1972. Since that time medical interest in the subject has grown apace, underpinned by a number of important discoveries pointing to the effectiveness of Acupuncture.

The ancient Chinese hypothesised that energy circulated in the body via specific channels, which they called meridians. They considered that the balance and transmission of this energy from side to side, top to bottom and from the inside to the outside of the body was of great importance. They expressed this idea using their doctrine of Yin and Yang, which considers that everything is an amalgam of opposites (the opposited being called Yin or Yang). Yang was associated with activity, fire, the sunny side of a hill or the male principle and Yin was associated with physical substance, water, the dark side of the hill or the female principle. The balance between these two opposites was considered to be constantly fluctuating, in other words it was a dynamic balance. If one was out of balance, in an energetic sense, the principle of treatment would be to re-establish that balance.

The Chinese had an essentially vitalistic approach to the body and its physiology in keeping with many ancient systems of medicine. It is interesting to reflect that modern Western medicine is the only such system ever to have existed without a vitalistic approach to health and disease.

The Chinese developed a highly complex and sophisticated system of empirical laws based on countless observations of illness and response to treatment. These laws resulted in a number of ground rules aimed at guiding a doctor to the improvement of his patient's condition. The astonishing fact is that the application of these apparently odd-sounding laws do appear to work in a highly significant proportion of patients. It can clearly be surmised that if it did no work, acupuncture would not have been adopted within both Western and Eastern cultures to such a degree.

The Chinese believed that in addition to being in balance, the energy or life force (which the Chinese called chi) had to be able to circulate freely around the meridians. If a break occurred anywhere in this circulation, illness would result. An example is backache, wich is viewed by the Chinese as a blockage in the "chi" circulating in the bladder meridian. The remedy was, put in the simplest terms, to insert a needle at the point of discomfort, thus encouraging flow to re-establish itself.

Each meridian refers to a particular organ, and the energy flowing through that meridian can be taken as indicating the functional state of that organ. Inserting a needle into a point on the liver meridian for instance could be expected to affect the function of the liver, the effect would depend on the actual point used and the state of the patient at the time of treatment.

-------------- HealthPoint allows you, without the use of needles, to stimulate points at which the energy flow is blocked. Gently apply the tip of the probe to the points which hurt. We call these "trigger points", the Chinese call them "Ah-Shi" (practically translated "ouch") points. HealthPoint technique can be as effective as traditional needle acupuncture. http://www.suresoft.com/health/healthpt/acupct.html

What is HealthPoint? HealthPoint is a safe, easy-to-use, hand-held instrument which offers drug-free pain relief and help for more than 150 common ailments.

How does it work? HealthPoint locates and stimulates precise points which are linked to Bio-electrical channels, called meridians, that run through our bodies. These are linked to magnetic points called Acupuncture points which stimulate the body's own healing system to function correctly.

What are acupuncture points? Modern science has now shown that these points discovered by Chinese doctors thousands of years ago are minute magnetic points with very low electrical resistance compared to normal skin (10:1). These points are all over the body and act like tiny switches when stimulated.

How do you find the right point? HealthPoint has a built-in detector that indicates with a light and a high-pitched buzz when you have found the spot (within 0.5 mm). You also feel a definite tingling sensation on the spot which is your confirmation that you are on the right spot. You should feel nothing otherwise.

Is it difficult to use? NO! It may take a little bit of practice to start with, but the unit comes with a good instruction video and a book showing all the treatment points.

Does HealthPoint have to be applied by a trained specialist? NO! The advantage of HealthPoint is that it is a self-treat unit, which has sophisticated technology enabling anybody to find the precise points to treat. HealtPoint is NOT invasive - it does not use needles, but a mild electronic impulse.

Is it safe? YES! HealthPoint is completely safe - so safe that you can use it on anyone - even young babies, the frail and the very old. The only people that should take guidance on using HealthPoint are those with a heart pacemaker and mothers in the early stages of pregnancy.

Can you overdo it? NO! You can use HealthPoint as often and as long as you feel necessary - the length and frequency of treatment will depend on the ailment yuo are treating and how badly you are suffering. In the treatment of children it is recommended that the intensity is set to the lowest setting to avoid any distress.

Is it effective? In about 80% of cases the patient will have a recovery or good relief.

How long does it take to work? In many cases it can work within minutes of the first treatment. Chronic problems may need daily treatment for a month, but eventually may even disappear completely for up to two years before more treatment is needed.

Is it like TeNS? NO! The TeNS machine, which is strapped on with sticky pads, uses electric current 3,000 times stronger than HealthPoint and works by blocking pain signals to the brain, and as it works with the nervous system is only for temporary relief of pain.

Does HealthPoint just mask the pain? NO! HealthPoint stimulates the body's own healing system without the use of drugs and helps re-start the healing process for the cause of the pain rather than just masking it.

Does HealthPoint actually cure things or just relieve the pain? With acute and chronic problems conditions, the stimulation of the body's own healing system can often lead to a full recovery.

How long does pain relief last? Pain relief can last for up to 24 hours between treatments. Chronic pain such as Arthritis can be pain-free for between six months and two years.

Can I reach every point on my body? HealthPoint's extension lead and probe mean you can reach almost everywhere, even on your back.

What are the ear clips for? The ear (auricular) clips are to treat conditions such as Stress, Drug Addiction and Anxiety.

What can be treated? Over 150 conditions are detailed in the manual; it is important that you have an accurate diagnosis of your condition before you attempt treatment with HealthPoint. Also see Ailments

What does the medical profession say about HealthPoint? This form of treatment is being used by medical practitioners all over the world. In Great Britain, where HealthPoint is manufactured, it is already in use in hospitals, GP surgeries and clinics and is growing steadily in popularity. Also see Testimonials. Jul 12 96

--------------------------------------------------------- One component of the ancient system of Chinese medicine. Though the underlying mechanism is not understood, acupuncture works by stimulating points on the surface of the body that affect bodily processes or, in some cases, specific systems. Acupuncture is among the most researched of the complementary medical systems and for some people can enhance the effectiveness of allopathic (Western medical) therapies for many chronic conditions. It is most often used in the West for control of pain.

--------------------------------------------------------- It is quite common these days to hear about people turning to acupuncture as a last resort for relief from chronic health problems. The popularity of alternative therapies such as acupuncture is variable among developed countries, but public demand is strong and growing. In recent surveys published in the Journal of Amer Med Assoc (98), the percentage of the public reporting use of at least one alternative therapy in the US increased from 38% in 90 to 42% in 97. Estimates avail from Europe show the corresponding percentage to be much higher, particularly for acupuncture and homeopathy (British Med Journal 94). A few years ago, the FDA estimated that 9 to 12 million acupuncture treatments were being performed annually, and this estimate is surely much higher now.

What is Acupuncture? Acupuncture was developed by the Chinese and has been in use for more than 3000 years. The practice is part of a larger integrated system, the Traditional Chinese Medicine (TCM) system. Simply put, acupuncture is performed by stimulating designated points on the bodythrough the insertion of needles, finger pressure, the application of heat, or a combination of all these treatments.

Network of energy According to the Chinese, there is a network of energy (called chi or qi) that flows through the body and connects acupuncture points through different channels called meridians. These channels are related to specific internal functions, and any imbalance in the flow of energy will cause a disease process. Therefore, the purpose of TCM and acupuncture assessments is to detect energy imbalance. Acupuncture assessments are made according to diagnostic categories of energy (qi) flow, as measured by a complete medical historyexamination of pulse, tongue, and other organs, as well as other observations. Any imbalance of energy detected through these comprehensive assessments is then corrected by application of acupuncture at carefully selected points. This restores the human body to normal health.

In its first encounters with acupuncture, Western medicine was understandably suspicious, since explanations of exactly how the procedure works are bound up in seemingly mysterious concepts formulated 3000 years ago. However, in light of recent advancements in understanding the neurophysiology of painand scientific explanations of how acupuncture relieves itsuspicion is giving way to tolerance and acceptance.

Acupuncture and Scientific Research Studies Findings emerging from both basic science and epidemiological research have been encouraging, since many studies have shown the potential usefulness of acupuncture. Some studies, however, have provided equivocal results because of methodological problems in conducting acupuncture research.

To address important research issues, the National Institutes of Health (NIH) Office of Alternative Medicine organized a 2 ½ week conference on acupuncture that took place in November of 1997. The panel concluded that research shows promising results in favor of acupuncture in both the treatment of nausea associated with chemotherapy and post-operative situations, as well as with post-operative dental pain. The panel also pointed to sufficient evidence that acupuncture may be a useful adjunct in the treatment of a variety of other conditions.

The way acupuncture works neurologically is also rapidly becoming apparent, speeding up its acceptance into traditional medicine. Needles used in acupuncture activate small nerve fibers in the muscle, which transmit impulses to the spinal cord and activate centers in the central nervous system, releasing a variety of neurotransmitters. Pain relief, for example, is mediated by the release of opioid-like substances. Although much still needs to be learned, the emergence of biological plausibility for the therapeutic effects of acupuncture is certainly encouraging.

While skeptics argue that acupuncture mediated response might be due to placebo, several reviews have concluded that it is more effective than placebo, indicating that it has a genuine physical effect.

In 1996, after careful review of acupuncture knowledge and research, the Food and Drug Administration (FDA) removed acupuncture needles from the category of
experimental medical devices.  This means that acupuncture is no longer considered to be experimental in nature.

Who Chooses Acupuncture? In my practice, I see patients who suffer from chronic painful debilitating medical problems. Many view the conventional health care system with skepticism and wonder why they could not be helped. Eventually, they turn to acupuncture to find relief from pain and other troublesome symptoms.

Supporters of acupuncture claim that this remedy is more accessible, and less expensive, than conventional medicine. Also, the effectiveness of conventional treatments is limited in treating chronic health problems. Chronic pain is a case in point. For example, treatment of pain associated with osteoarthritis and fibromyalgia with non-steroidal anti-inflammatory drugs (NSAIDS) is seldom beneficial. Additionally, patients are concerned about side effects associated with surgery and conventional medications. An article in the Journal of the American Medical Association (1998) estimates there are 100,000 deaths each year in U.S. hospitals caused by pharmaceutical drugs.

Who Benefits From Acupuncture? Patients who seek acupuncture are mainly those who suffer from long-standing chronic problems such as back and neck pain, headaches and migraines, arthritis, cancer, neurological disorders, anxiety, and depression. These problems strike women more than men, which could certainly explain why currently more women  are using acupuncture than men.

Conventional healthcare providers are beginning to view acupuncture as an effective complementary modality to conventional care, and its use is being recommended more and more. Acupunture is also gaining a reputation for efficacy, and as an attractive drug- and surgery-free option for many patients. An extensive review of studies has shown that acupuncture is effective for the following conditions:

•Pain. Examples of pain producing conditions that respond favorably to acupuncture include arthritis, myofascial pain syndrome, dental pain, neck and low back pain, carpal tunnel syndrome, and fibromyalgia. •Headache and migraines. •Nausea associated with chemotherapy. •Substance abuse problems, such as those related to cocaine, heroine and nicotine. •Menopause and PMS related symptoms. •Asthma and allergies. •Stroke.

Further research is likely to reveal additional areas where acupuncture interventions will become useful.

How is Acupuncture Performed? Acupuncture is done with extremely thin, flexible needles made of steel metal alloy. There is nothing special about the needle itself; it is merely a tool used to correct the energy imbalance in the body (or to release neurotransmitters). There is often a brief pricking sensation when the needle passes through the skin. As the needle begins to work and effects begin to occur, the patient may feel numbness, heat, dull aching or a tingling sensation in the vicinity of the needle insertion. Generally, the needles are left in place for about 15 to 30 minutes.

They may be rotated by the practitioner or stimulated by electricity or heat. Most side effects associated with acupuncture are minor and transient. They include occasional dizziness, light-headedness, and very slight bleeding after needles are withdrawn. Infection and other serious side effects such as lung puncture are rare. Patients should always insist that the acupuncturist use sterile and disposable needles to avoid the risk of infectious diseases such as Hepatitis B and AIDS.

Some Practical Matters - It is reported that several thousand Americans receive acupuncture treatments each year. Access to qualified practitioners is of paramount importance. The health care systems should facilitate and allow for effective communication between acupuncturists and conventional health care providers, since integrating acupuncture with conventional care will better serve the interests of our patients.

Finding an acupuncturist in your area - Most states allow the practice of acupuncture. To locate a physician acupuncturist, call your local medical society or hospital based pain or complementary medicine service. You may also call the American Academy of Medical Acupuncture (1-800-521-2262) to obtain names of physicians who practice acupuncture in your area.

Certification - Lay acupuncturists, who are non-MDs, should have a state license and be certified by the National Commission for the Certification of Acupunc-turists, which requires acupuncturists to pass an exam after a suitable period of training.

Medical insurance - Many patients have limited access to acupuncture care because they are unable to pay. At the present time, populations served by Medicare and Medicaid are not eligible for acupuncture care. An increasing number of employers and ins companies are considering the possibility of coverage for acupuncture services. If you are unsure about your coverage, call your insurance company to get information specific to your situation.

Integrating conventional and acupuncture methods of care Before seeking acupuncture treatments for your health problem, you should undergo a thorough conventional evaluation by your own physician. Have the acupuncturist explain acupuncture in detail and be sure your doctor and acupuncturist communicate with each other.

Conclusion - Acupuncture shows promise as one of the many healthcare options available to patients. Its role as an adjunct in the mgmnt of a select number of conditions, particularly chronic pain, should be explored. Its use should be given serious consideration, particularly by persons who are concerned about the efficacy and side effects of surgery or medications for pain relief.

While it is not being suggested that acupuncture provides a cure for all problems, there is sufficient evidence that, if appropriately used, this discipline of medicine can successfully complement conventional treatments so as to provide patients with the best healthcare available.
 Ravinder Mamtani, MD.


\7 Shiatsu

a system based on the energy meridians. Shiatsu massage is normally done fully clothed and involve the pressing of points on the body and the stretching and opening of the energy meridians. Shiatsu is somewhat related to acupuncture, which is a form of anaesthesia and therapy used in Chinese hospitals for surgery. Its proponents view it as a form of treatment alternative to medicine or surgery.

Shiatsu is a japanese word meaning finger pressure. Shiatsu uses varying degrees of pressure to balance the life-energy that flows through specific pathways (meridians) in the body.

Tension is released and weak areas are strengthened to allow for even circulation, cleansing of the cells, and improved vital organ function.

Shiatsu can diagnose, prevent and relieve many chronic and acute conditions manifesting on both physical and emotional levels. Shiatsu massages are normally done fully clothed.

SHIATSU - Shiatsu is a traditional Japanese massage therapy, based on the same principles as acupuncture, and is used to manage and treat pain as well as to maintain health. Translated literally, Shiatsu means "finger pressure" - natural bodyweight is used to apply pressure, gently but rhythmically, onto the acu-points on the body. Shiatsu is not only about finger pressure, though, but also about the use of palms & elbows etc. to bring pressure to bear on the acu-points.

The acu-points referred to are exactly the same points used in other forms of meridian based therapies such as acupuncture. The meridian system comprises a total of more than 400 acu-points joined together by twelve main meridians. These meridians are channels for energy (Qi or Chi in Chinese, Ki in Japanese), and each meridian is named for and corresponds with a specific organ - an exception being the Triple Heater, a meridian that relates to several organs. The functions of the meridians can be summarised as follows:

The regulations of breath, water & blood in the body. A communication system for exchanging information between the acu-points (both internal and external) of the body.

Acu-points are known to be highly conductive on the actual surface of the body - an example of this is the so-called SQUID tests performed on the human scalp: using a Superconducting Quantum Interference Device, these tests indicated that one of the major meridians, the Governing (or Governor) Vessel, forms a major electrical pathway on the scalp, and that it also forms the basis of the divide between the two directions of electrical current in the brain. Coupled to this, the Governing Vessel also separates the body into two symmetrical parts.

According to Traditional Chinese Medicine, Qi is transmitted throughout the body along these electrical - or energy pathways. Although the energy itself is invisible, the effects of the flow of energy are clearly visible, e.g. when a wound heals itself. While some of the effects of Shiatsu and other forms of acupressure can be observed via the nervous system, the meridian system is a separate and distinct energy-conductive system which overlaps and interacts with other systems such as the nervous and circulatory systems.

When blockages occur in the energy pathways, illness or disease follows - in other words, the body becomes ill when the energy stagnates. In Shiatsu these blockages are "unblocked" through the stimulation of the acu-points where the blockages occur. By manipulating the flow of energy in these meridians or energy pathways, the body is permitted to naturally regain its balance. When this natural balance is reached, according to Traditional Chinese Medicine, the corrected energy flows will also ensure that any affected organs function properly.

According to Charles Chang of the Boston University's School of Medicine, intrinsic energy fields and currents are important factors in growth control, cell development and cell migration. The manipulation of these fields can help to contain growths, as well as to improve the flow of energy to affected or diseased areas. As an example, it has been shown that a number of cells, including neurons, are sensitive to electric fields. Some fast-growing tissues such as tumours are electrically negative in polarity. Where changes to the polarity have been applied, the growth of these tissues has been retarded or even regressed. This is seen as another positive indication of the existence of electrical flows in the body.

From a technical theoretical perspective, the conductance of the acu-points may vary in accordance with an individual's physical, mental and emotional state. Disease is another factor, which influences not only the conductivity of the acu-points, but also the flow of communication between the different points along the meridians. According to the model presented by Chang, any abnormality or blockage inside the network (i.e. the points on the meridian system) can be detected by measuring the electrical parameters at these points.

As an example, malfunctions in certain organs can be preceded by changes in the normal electrical parameters at certain specific points, and the malfunctions can be treated or rectified by the manipulation of the interconnected points. As the primary function of Shiatsu is the realignment of the meridians by the manipulation of the energy flows and pathways such as the Governing Vessel, it can be seen why and how this realignment can positively affect the patient's health and general well-being.

Shiatsu is often not used only to realign the energy flows in the bodies of ill people, but also to relieve the effects of the pressure of our fast-paced living. The therapeutic effects of a Shiatsu massage is especially effective for those of us who suffer from work related stress and anxiety, induced by the work-ethic to keep on performing at the highest level regardless of the physical, mental or emotional consequences. The effects of this type of work ethic normally present as tension headaches, PMS, Migraines and constant fatigue. The results of Shiatsu treatments in these cases are normally exceptionally rewarding, as these patients report a feeling of general well-being, improved vitality, more energy and improved performance levels. Also important is that contrary to the side effects of most medicines, very few negative side effects to a Shiatsu session have been recorded.

How is a Shiatsu session performed? Shiatsu can be applied through a layer of clothing or directly onto the skin. Some Shiatsu practitioners feel that if pressure is applied directly onto the body, interference from the sensitive nerve endings or sensory fibres of the body might occur.

Each Shiatsu session is different, as individuals have different tolerances, and the imbalances in their energy flows have different response to the same treatment. An experienced and skilled practitioner will adapt to the individual's needs and responses.

After determining where the blockages in the energy pathways are, the Shiatsu practitioner will begin the session with a gentle kneading / stretching process, to relax the muscles and also to stimulate the flow of energy to the affected areas. The kneading process would in most instances give way to a more rigorous massage, as more pressure might need to be brought to bear on selected acu-points. The duration and intensity of the pressure on any one acu-point will vary depending on where the blockages occur, and the way the practitioner perceives the response to the applied pressure.

Generally, where a Shiatsu massage is performed for relaxation or the relief of tension-related symptoms, the massage is very gentle and pleasant - so much so that some patients even fall asleep during the session!

Toru Namikoshi's Complete Book of Shiatsu Therapy ISBN 0 87040 461 x claims to be the definitive work)


\8 taking naps

Conscious relaxing meditation 20 min daily can bring significant relief. Blood pressure will fall, muscles relax, breathing will slow. Tapes, books, movies can help.

ÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄ You must sleep sometime between lunch and dinner, and no halfway measures. Take off your clothes and get into bed. That's what I always do. Don't think you will be doing less work because you sleep during the day. That's a foolish notion held by people who have no imaginations. You will be able to accomplish more. You get two days in one -- well, at least one and a half." --Winston Churchill

As a short sleeper who is rarely in bed for more than six hours a night, I'm a strong believer in naps for recharging my batteries. Sir Winston and I are in good company. Napping enthusiasts have included Albert Einstein, Napoleon Bonaparte, Thomas Edison and at least three presidents: John F. Kennedy, Ronald Reagan and Bill Clinton. Besides, sleep researchers have shown that regardless of how long one sleeps at night, the human body is programmed to become sleepy in the early afternoon, even without a big lunch.

Losing Sleep This is the second of two columns on sleep debt. Last week: cheating on sleep.

"Napping should not be frowned upon at the office or make you feel guilty at home," writes Dr. James B. Maas, a psychologist and sleep expert at Cornell. "It should have the status of daily exercise." In the old days, people would doze for an hour or so after the midday meal, and in some Latin American and European countries siestas are still in vogue. But in most industrialized nations, the usual response to the afternoon sag in energy is to try to jump-start the system with caffeine, a tactic that sleep experts say is actually counterproductive, creating only the illusion of efficiency and alertness and depriving the body and brain of much-needed sleep.

How Naps Help Now, however, there is growing evidence that restorative naps are making a comeback. Recognizing that most of their employees are chronically sleep-deprived, some companies have set up nap rooms with reclining chairs, blankets and alarm clocks. If unions are truly interested in worker welfare, they should make such accommodations a standard item in contract negotiations.

Workers who take advantage of the opportunity to sleep for 20 minutes or so during the workday report that they can then go back to work with renewed enthusiasm and energy. My college roommate, Dr. Linda Himot, a psychiatrist in Pittsburgh, who has a talent for 10-minute catnaps between patients, says these respites help her focus better on each patient's problems, which are not always scintillating. And companies that encourage napping report that it reduces accidents and errors and increases productivity, even if it shortens the workday a bit. Studies have shown that sleepy workers make more mistakes and cause more accidents, and are more susceptible to heart attacks and gastrointestinal disorders.

A NASA scientist's study showed that 24-minute naps significantly improved a pilot's alertness and performance on trans-Atlantic flights. (The co-pilot remained awake.) Dr. David Dinges, a sleep researcher at the University of Pennsylvania, is a strong advocate of prophylactic napping -- taking what he and others call a "power nap" during the day to head off the cumulative effects of sleep loss. He explained that the brain "sort of sputters" when it is deprived of sufficient sleep, causing slips in performance and attentiveness and often resulting in "microsleeps" -- involuntary lapses into sleep, in which accidents can occur.

A brief afternoon nap typically leaves people feeling more energized than if they had tried to muddle through without sleeping. Studies have shown that the brain is more active in people who nap than in those who don't sleep during the day.

Dr. Maas, the Cornell psychologist and author of "Power Sleep" (Villard Books, 1998), points out that naps "greatly strengthen the ability to pay close attention to details and to make critical decisions." He also states that "naps taken about eight hours after you wake have been proved to do much more for you than if you added those 20 minutes onto already adequate nocturnal sleep."

There are two kinds of naps: brief ones taken to revive the brain and long ones taken to compensate for significant sleep loss. The reviving workday nap should not be longer than 30 minutes; any more and the body lapses into a deep sleep, from which it is difficult to awake.

How and When to Nap Long naps help when you've accumulated a considerable sleep debt -- for example, when the previous night's sleep was much shorter than usual, or when you know you will have to be alert and awake considerably later than your usual bedtime. I usually try to nap for an hour or more before attending a play, concert or late party. But long naps have a temporary disadvantage: they cause what researchers call sleep inertia, a grogginess upon awakening that can last about half an hour. Also, long naps can affect the body's clock, making it more difficult to wake up at the proper time in the morning.

As Dr. Maas maintains, "Brief naps taken daily are far healthier than sleeping in or taking very long naps on the weekend." They are also far better than caffeine as a pick-me-up. "Consumption of caffeine will be followed by feelings of lethargy and reduced R.E.M. (or dream) sleep that night," Dr. Maas writes. "A debt in your sleep bank account is not reduced by artificial stimulants."

He suggests that naps be scheduled for midday because late-afternoon naps can cause a shift in your biological clock, making it harder to fall asleep at night and get up the next morning. To keep naps short -- 15 to 30 minutes, set an alarm clock or timer. Westclox makes a gadget called Napmate, a power-nap alarm clock that has a one-button preset so you can program your nap to last for a specific number of minutes. If you can lie down on a couch or bed, all the better. If not, use a reclining chair. You need not follow Churchill's advice to get undressed, but make yourself as comfortable as possible. Lap robes are very popular and inexpensive; if a blanket helps you to doze off, use one.

Try to take your nap about the same time each day. Dr. Maas recommends a nap eight hours after you wake up (in the middle of your day, about eight hours before you go to bed at night). Even on days when you don't feel particularly sleepy, he suggests taking a rest rather than a coffee break at your usual nap time.

There are special cases. People who have trouble falling asleep at night might be wise to avoid daytime naps. Parents of newborns should nap when the baby does, rather than using all the baby's sleep time to do chores.

Finally, naps are often essential for people trying to work through illness, injury or chemotherapy, even if they get adequate sleep at night. A woman I know who continued working while receiving cancer therapy napped each day on the floor under her desk. Like so many workplaces, hers had no suitable place to rest.

PERSONAL HEALTH. New Respect for the Nap, a Pause That Refreshes by JANE E. BRODY.


\9 The Body of Light (Astral Projetion)

Like everything else, the Body of Light technique requires practice, but you are not asked to hold yourself balanced in a hypnogogic state or take control of your dreams. all you are asked to do is use your imagination. Begin by finding a comfortable chair in a room where you will not be disturbed. Then relax, using any method you find works for you. Deep, trance-like relaxation is definitely not required. Simply let go of your worries and muscular tensions so you can concentrate on the job at hand. Now imagine you are no longer seated in your chair, but standing in the room at a spot about six feet away.

Try to visualize yourself standing there as clearly as you can. Make a real effort to paint in detail. Don't just settle for a vague, imaginary shape. Try to 'see’ what you are wearing. Imagine the scuff marks on your shoes. Count the buttons on your jacket. Note the way your hair falls over one eye. Examine the expression on your face. Visualize in colour and in depth. (Muldoon’s mirror exercise is a really excellent preliminary to this technique since it familiarizes you with your own appearance.)

It is perfectly acceptable to visualize yourself as you are in reality – i.e. dressed in sweater and jeans, or whatever – but some romantic souls find it easier, or possibly just more fun, to see themselves as a mysteriously robed and hooded figure. That is okay too, but pay attention to detail – mysteriously robed and hooded figures do not all look the same. Spend as much time as you need to build up this imaginary figure fully. A good idea is to set aside a particular time each day for the exercise and devote 10 to 15 minutes daily to it for a week or more.

Avoid rushing this preliminary stage: it is actually the most important part of the whole exercise, the creation of the ‘Body of Light’ after which it is named. As you practice, you will find the visualization becomes progressively easier until a simple effort of will is enough to call it up in its entirety. Once you have reached this stage, proceed to phase two of the exercise. Phase two involves you imagining that you are rising from your chair and walking around the room. Close your eyes and try it out.

Remember how the room appears from the viewpoint of your chair, close your eyes and try to visualize that same scene. If you find the details difficult, open your eyes again for a refresher. Keep working at it until you are perfectly capable of describing the room in detail with your eyes closed. With this achieved, imagine yourself rising from your chair and walking slowly round the edges of the room in a clockwise direction. Try to see in your mind’s eye how the perspective of the room changes as you move. Try to remember those small objects and ornaments which were not necessarily visible from your chair, but which you know to be in the room nonetheless. If you have difficulty with this part of the exercise, open your eyes, stand up physically and walk clockwise around the room. Then sit down, close your eyes again, and try to duplicate the journey in your imagination. Keep working on it until your visualization becomes easy and vivid. Now try the same walk anti-clockwise. After a time – and how much time varies with the individual – you will discover the visualization no longer requires much effort. When this happens, try visualizing yourself in another room, again walking around it first clockwise, then anti-clockwise. Select a room you know well, but try visualizing without first visiting it if at all possible. You should find your mental pictures of the second room come faster and easier than the first since you are, of course, exercising your visualization ability. When you have thoroughly explored the second room, mentally extend your range and visualize yourself wandering throughout your entire house. Many people visualize extremely well and have little difficulty with any of this. If you are not so fortunate, keep trying: there is no time limit on the exercise and practice will eventually bring it right. Just don’t devote more than, say, 20 minutes each day to the practice: this is more than enough, so long as you practice regularly. The final step in this stage is to imagine yourself exploring some more distant and less familiar scene. Indoors is easier to most people, but if you are feeling really confident, you might try imagining yourself in an outdoor location. Once again, you should explore methodically. Avoid visualizing people during any part of this exercise since this will introduce complications, which will slow your progress. When you are totally happy that you can quickly and easily visualize any area you set your mind to – and visualize it in detail – you are ripe to move on to the final stage of the exercise. This is the crunch. You have now trained yourself to do two things. One is to visualize a sort of mirror image of yourself standing some distance from where you are seated in your chair. The other is to imagine yourself walking around various locations and examining them in detail. For your great leap forward, you are now going to combine the two previous aspects of the exercise. First, visualize the mirror image of yourself exactly as before. Do this with your eyes open if at all possible. When the figure is definitely there and stable, imagine yourself looking out from its eyes. There is a knack to this, rather like learning to balance on a bicycle. The first few times you try, you will probably fail. But then, for no apparent reason, you will suddenly find you can do it. Imagine the room from the viewpoint of the figure you have created. Look around and note the details, including your own (physical) body seated in the chair. Once you feel the focus of your perceptions is firmly seated in this imaginary body, have it walk around the room in a clockwise direction, exactly as you did in your imagination during the second stage of the exercise. Since you have already practiced this again and again, you should find it relatively easy to maintain the new perspective. But if you find your consciousness flickering back to where you are sitting in the chair, don’t let that worry you. Simply start up again from the beginning. As you continue with this exercise over a period of time, projecting your focus of consciousness into the imaginary body and having it carry you from room to room, one of two things will happen. Either you will gradually find the reality tone of the experience increases until you can ‘see’ vividly from the new body, or you will reach a stage where there is a sudden ‘jump’ after which the experience of the new body seems far more real to you. At this point, try exploring a totally unfamiliar area while in this imaginary body, then visit the same area when you get back into your physical body. (Which, incidentally, you do by reversing the initial process: from the viewpoint of your new body, simply visualize how your room looks from the physical body sitting on the chair.) Do not be too shocked if you discover that the scene you saw while in your imaginary body is confirmed in every detail when you visit the spot in reality. What, you might reasonably wonder, is going on here? If you have successfully followed the technique all the way through, it seems fairly obvious that you have managed to project your consciousness into a second body, that you have, in essence, created a phantom. But while this body can take you anywhere you want to go – and pass through solid walls in the process – it is equally evident that there are substantial differences between the experience and the sort of projections described by people like Monroe and Muldoon. Where, for example, is the separation of one body from the other? In this exercise, you did not actually separate anything from anything – you simply imagined a second body standing in the corner. And where was the peculiar state of consciousness apparently so necessary for etheric projection, the hypnogogic borderline between sleep and waking? Where was the physical incapacity? You were in a perfectly normal state throughout and if you want to move your physical body you could do so with no trouble whatsoever. Whatever the similarities, you might be tempted to conclude you were not projecting your etheric body at all. And you would be right. The Body of Light technique brings you closer to something even more exciting than stepping out in your etheric body. It introduces you to astral plane projection.

Project yourself out of your body and explore.

Requirements: Quiet room, comfortable chair Source of info "Discover Astral Projection - How To Achieve Out-Of-Body Experiences" by J.H. Brennan

Submitted by John Vianney