 1 feet (podiaty)
 2 Japan/Okinawa has old/Hyaluronic Acid
 3 Effects of Aging
 4 the future (2 articles)
 5 social aids
 6 social consider
 7 sleep problems
 8 12-Step Program for a Healthier Lifestyle Low-Fat Food Made Fun!
 9 Optimism could be key to prolonging life, study finds


\1 feet (podiaty)


YOUR PODIATRIC PHYSICIAN TALKS ABOUT AGING Info From The American Podiatric Medical Assoc. 

Medicine and health awareness have progressed so rapidly since 1900 that life expectancy of the average American has increased by about 30 years. Older persons have become an increasingly significant proportion of our total population -- and their numbers are growing rapidly. In 1900, for example, there were three million Americans aged 65 or older. In the year 2000, older people outnumber children for the first time in history. 

If older people are to live useful, satisfying lives, they must be able to move about. Mobility is a vital ingredient of the independence that is cherished by our aging population, and foot ailments make it difficult or impossible for them to work or to participate in social activities. 

According to the US National Center for Health Statistics, impairment of the lower extremities is a leading cause of activity limitation in older people. As if foot problems weren't enough of a nuisance, they can also lead to knee, hip, and lower back pain that undermine mobility just as effectively. The NCHS says one-fourth of all nursing home patients cannot walk at all and another one-sixth can walk only with assistance. 

Mirror of Health - The human foot has been called the mirror of health. Foot doctors, or doctors of podiatric medicine (DPMs), are often the first doctors to see signs of such systemic conditions as diabetes, arthritis, and circulatory disease in the foot. Among these signs are dry skin, brittle nails, burning and tingling sensations, feelings of cold, numbness, and discoloration. Always seek professional care when these signs appear. 

Foot Problems Can Be Prevented - For reasons that are difficult to fathom, many people, including a lot of older people, believe that it is normal for the feet to hurt, and simply resign themselves to enduring foot problems that could be treated. 

There are more than 300 different foot ailments. Some can be traced to heredity, but for an aging pop, most of these ailments stem from the cumulative effect of years of neglcct or abuse. However, even among people in their retirement years, many foot problems can be treated successfully, and the pain of foot ailments relieved. 

Whether due to neglect or abuse, the normal wear and tear of the yrs causes changes in feet. As persons age, their feet tend to spread, and lose the fatty pads that cushion the bottom of the feet. Additional weight can affect the bone and ligament structure. Older people, consequently, should have their feet measured for shoe sizes more freq, rather than presuming that their shoe sizes remain constant. Dry skin and brittle nails are other conditions older people commonly face. Finally, it's a fact that women, young and old, have four times as many foot problems as men, and high heels are often the culprits. 

Observing preventive foot health care has many benefits. Chief among them are that it can increase comfort, limit the possibility of additional medical problems, reduce the chances of hospitalization because of infection, and lessen requirements for other institutional care. 

Keep Them Walking - Studies show that care for a bedrid- den patient costs much more than care for an ambulatory patient. In their private practices and in foot clinics, podiatric physicians are providing services designed to keep older people on their feet, and they serve in hosps and nursing homes across the country. 

Records indicate that amputations and other forms of surgery due to infections of the feet, many brought about by diabetes, have been significantly reduced in recent years because of early diagnosis and treatment. Further reduction in this area is a goal of Healthy People 2010, a US Dept of Health campaign endorsed by podiatric docs, to encourage understanding and application of preventive medical practices. 

Foot Health Tips - Properly fitted shoes are essential; an astonishing number of people wear shoes that don't fit right, and cause serious foot problems. 

A shoe with a firm sole and soft upper is best for daily activities. 

Shop for shoes in the afternoon; feet tend to swell during the day. 

Walking is the best exercise for your feet. 

Pantyhose or stockings should be of the correct size and preferably free of seams. 

Do not wear constricting garters or tie your stockings in knots. 

Never cut corns and calluses with a razor, pocket knife, or other such instrument; use over-the-counter foot products only with the advice of a podiatrist. 

Bathe your feet daily in lukewarm (not hot) water, using a mild soap, preferably one containing moisturizers, or use a moisturizer separately. Test the water temperature with your hand. 

Trim or file your toenails straight across. 

Inspect your feet every day or have someone do this for you. If you notice any redness, swelling, cracks in the skin, or sores, consult your podiatrist. 

Have your feet examined by a DPM at least twice a year.

General Foot Disorders  Aging Arthritis Bunions Athlete's Foot Diabetes Flying Foot and Ankle Injuries Foot Health Footwear Forefoot Surgery Fungal Nails Hammertoes Heel Pain High Blood Pressure Nail Problems Neuromas On-the-Job Foot Health Orthotics Rearfoot Surgery Walking Warts 

\2 Japan has old

By the year 2025, some 26% of Japan's pop will be over 65 years old, meaning that society and families will need to cope with the various needs of 32 million aged people. Since I plan to join that group by then, it is encoura- ging that there are strong advocates of better prepar- ation and improved care for the elderly and a govt that appears willing to innovate and make this a priority in social policy.

This book presents an array of papers on a broad range of elderly-care issues ranging from govt policies, cultural constraints and care provision to dealing with dementia on an individual level. One can only hope that the prog- ressive perspectives espoused here are incorporated into formulating and implementing elderly-care initiatives over the coming decades.

The implementation of the Kaigo Hoken (Long Term Care Insurance Law, 1997) is welcomed by most of these contributors as a significant advance in the way Japan has approached the problems of dealing with elderly care.

These papers were written before its implementation in April, 2000 and the postponement of premium collection forced by then Liberal Democratic Party executive Shizuka Kamei in late 1999. Here the new law is assessed in terms of its departure from previous government policies and its innovativeness on an international level. Rather than following the Scandinavian social-welfare model, the Kaigo Hoken scheme is more of a market-based social- insurance policy that minimizes bureaucratic interference and provides vouchers for the purchase of health-care- related services. 

In contrast to a similar German plan implemented in 1994, the Japanese system has a much lower threshold for eligibility, higher allowances, less rigorous assessment and no cap on spending growth. Unlike the German plan, recipients receive no cash. Instead, they get vouchers that can be redeemed at approved care providers ranging from hospitals to nonprofit organizations. 

Kamei argued to no avail for a cash system that would effectively allow recipients to pay family members for services rendered. Various advisers to the Ministry of Health and Welfare lobbied against such a provision because it would merely perpetuate the shouldering of care-provision responsibilities by female members of the household.  Indeed, one of the goals of Kaigo Hoken is to relieve wives, daughters and daughters-in-law of this burden and to update government policies to take account of recent demographic and economic trends. 

The new law is a recognition that the family has been overburdened by the absence of government initiatives concerning elderly care and that it has also changed considerably in the postwar decades. In addition, too many women have been forced to sacrifice their careers and health to the rigors of elderly care because of the absence of support services. Belatedly, society has recognized the costs and folly of assuming that the family and its female members would naturally serve as the foundation of elderly care in a context of considerable transformation in the family and in women's participation in the labor force.

The Kaigo Hoken program collects premiums from all Japs with incomes, after the age of 40, and in turn provides them with institutional or community-based long-term care in the event of an age-related disease or disability. 

This has removed the stigma of "social welfare" from those seeking to use the system. In addition, there will be less of an economic incentive than existed until 2000 to hospitalize elderly people (covered by health ins.) rather than placing them in nursing homes (rigorously screened with costs linked to income). This will hopefully rescue many old people from unnecessary levels of care in dismal hospital wards.

The rub is that poorly prepared local governments are implementing this system, costs will most likely vastly exceed projections and there may not be enough of the needed community-based services in certain areas because not all market opportunities will be exploited. This means that there will be a period of confusion and inadequate service that may rob the system of public confidence and near-certainty that premiums will rise sharply to meet the costs of a system lacking effective cost-control provisions.

Kiyoshi Adachi further complains that the Kaigo Hoken reflects the same pattern of exclusionary paternalism that is typical of central-government policymaking. It is telling that neither the Japanese people nor local government were systematically consulted in the drafting of the new law. Adachi favors a participatory welfare system that allows citizens to join in the planning and decision-making processes of policymaking.

In her introduction, Susan Orpett Long reflects on the political responses to social change, arguing that "the definition of aging as a social problem is thus not an objective crisis of demo- graphy, but a crisis in the significance of biological aging, family relationships, and relations between individuals and the state. 

In the past, families might be expected to incorporate multiple meanings of care, the physical and the inter- personal. Providing nursing care, giving financial support, and maintaining the social meaning of life of an old person converged historically in the family. As this has come to be challenged in government programs and private circumstances, some people have advocated a return to the era of family caregiving for the elderly. 

Yet to do so is to disregard the tremendous demographic and social changes that have led to more active and more independent lives for longer periods for many older adults, and to longer periods that the elderly live with debilitating diseases that leave them dependent on others."  The unprecedented stress on families, and women in particular, related to long-term elderly care in both the United States and Japan reveals both differences and similarities in how people in both nations are coping. 

The popular image of Americans dumping their elderly into institutions is shown to be wide of the mark, while family-based care in Japan falls well short of the desired ideal. Culture plays a significant role in shaping elderly-care policies: For the Japanese, there is a strong preference for a predictable and secure system while Americans prefer flexibility and contingency planning. In Japan there is a tendency for sustained, reciprocal, intergenerational assistance, while in the US children tend to help parents only after a crisis. 

As for public-policy implications, Ruth Campbell and Berit Ingersoll-Dayton argue that "the more 'crisis- oriented' American experience has not produced a unified ground swell for a comprehensive national policy of relief for caregivers. In the U.S., the emphasis on the individual leads Americans to assume their situation is unique to their family, whereas in Japan the more institutionalized role of family care and the daughter-in-law's responsibility, in particular, make it seem more like a societal problem."  This excellent volume approaches this societal problem from various angles and points out the difficult choices that lie ahead for both nations and for all of us and our families.

The authors deserve kudos for tackling such a complex issue with perspicacity and sympathy. Their book serves as a tribute to the Abe Fellowship Program and Center for Global Partnership that funded research and facilitated workshops leading to its publication.  One can only lament that it is priced for libraries.

Two perspectives on a gray tomorrow   CARING FOR THE ELDERLY IN JAPAN AND THE U.S.: Practices and Policies, edited by Susan Orpett Long. Routledge: London, 2000. 358 pp., $100.  Reviewed by JEFF KINGSTON. Jeff teaches history at Temple University Japan.  The Japan Times: Mar. 6, 2001

Exploring Okinawans' Recipes for Longer Lives By JOHN LANGONE May 15 2001 

"The Okinawa Way: How The World's Longest-Lived People Achieve  Everlasting Health" By Dr. Bradley J. Willcox, Dr. D. Craig Willcox, and Dr. Makoto Suzuki Clarkson Potter/Publishers, $24.95. he Okinawa Way: How The World's Longest-Lived People Achieve Everlasting  Health," by Dr. Bradley J. Willcox, Dr. D. Craig Willcox, and Dr. Makoto  Suzuki, Clarkson Potter/Publishers, $24.95.

Envy the Okinawans, the inhabitants of the 161 islands that stretch 600  miles between Japan and Taiwan. When Okinawans die, it is at the average  age of 86 for women, and over 75 for men, making them the longest-lived  people in the world.

Their population includes more than 400 centenarians of 1.3 million  (about 33 per 100,000) compared with 5 to 10 per 100,000 in the United  States. Heart disease is minimal, stroke rate is remarkably low, breast  cancer is so rare that mammograms are not necessary and most aging men  there have never even heard of prostate cancer. 

What accounts for this astonishing Shangri-La-like situation? What do  the Okinawans know and do that we don't? Is it in their genes? Can we  emulate them? 

For starters, this book, based on a 25-year centenarian study among  Okinawans, dispels the notion that genetics explains the population's  advantage in avoiding illnesses like arterial disease. "When Okinawans  and other Japanese grow up in another country and abandon their  traditional ways," the authors argue, "they take on the same arterial  disease risk as those in their adopted country."

"Their genetics have''t changed, but their lifestyles have undergone  profound alterations," the authors said.

So what it all boils down to is that catch-all word, lifestyle, which  translates, in every book of this sort, into proper diet, exercise and  "spirituality."

And the Okinawans, it appears, have made it all a science that pays off.  We learn that Okinawan elders eat a daily average of seven servings of  vegetables and fruits, seven servings of grains and two servings of  flavonoid-rich soy products. They also eat omega-3-rich fish several  times a week and minimal dairy products and meat.

Exercise on the islands is a way of life — martial arts, traditional  dance (which many Okinawan men and women learn at an early age) and lots  of gardening and walking. Moreover, say the authors, the exercise  connects organically with, and reinforces, spiritual beliefs "which may  just give them an extra shot of healing power." 

Now, whether Americans can follow the whole regimen (three servings a  day of Japanese sticky rice supplemented by buckwheat and wheat noodles  may not be too enticing) is debatable.

Some of it makes sense, of course, but altering one's cultural habits  and mindset is no easy task. Whether we pick up chopsticks for the rice,  or a fork and knife to cut into a thick steak depends, the authors  acknowledge, "on whether we were born in Okinawa or Oklahoma." 

Could Hyaluronic Acid Be an Anti-Aging Remedy?  Like many of his peers who routinely live into their 90s and longer, Tadanao Takahashi, 93, is in good health. Japanese researchers think this phenomenon may be connected to the local diet. 

Nov 2 00 Every morning, Hiroshi Sakamoto wakes up and farms his field, usually for about four or five hours a day. Sakamoto, who lives in the village of Yuzuri Hara, two hours outside of Tokyo, is 86 years old. But his age by no means makes him the elder statesman of his village, nor is a daily routine like his uncommon among his peers.
 More than 10% of the pop of his village is 85 or older, 10 times the American norm. The residents of Yuzuri Hara are not only living longer, but they are also quite healthy. Rarely do they have any reason to see a doctor, and they are hardly affected by diseased like cancer, diabetes and Alzheimer's. Many have even managed to keep their skin from showing signs of aging. What makes the residents of Yuzuri Hara even more remarkable is that they are living long, healthy lives even those who engage in unhealthy activities. 

Sakamoto, for example, smokes a pack and a half of cigarettes daily and is still in reasonably good health and physically fit. Tadanao Takahashi, 93, has worked in the sun for 50 years, never once using sun block or skin cream, and yet his skin is soft and smooth. 

Some medical researchers believe that Yuzuri Hara, known as -The Village of Long Life,- and its residents may hold the key to anti-aging secrets: the local diet that is unique to the village. Unlike other regions of Japan that grow rice, Yuzuri Hara’s hilly terrain is better suited to harvesting different carbohydrates that may prove healthier: things like satsumaimo, a type of sweet potato; satoimo, a sticky white potato; konyaku, a gelatinous root veg concoction; and imoji, a potato root.

The Secret Ingredient Dr Toyosuke Komori, the town doctor who has studied and written books on longevity in Yuzuri Hara, believes these locally grown starches help stimu- late the body's natural creation of a substance called hyaluronic acid, or HA, which aging bodies typically lose. This may ward off the aging process by helping the cells of the body thrive and retain moisture, keeping joints lubricated, protecting the retina in eyes and keeping skin smooth and elastic.

I have never seen anyone suffer from skin cancer here, he says. I have seen a woman in her 90s with spotless skin. One of Japan's leading pharmaceutical companies began researching and developing a pill supplement containing hyaluronic acid. The company tested the pills on 1,000 people, and said roughly half reported smoother skin, less fatigue and better eyesight. In the US, hyaluronic acid has been used for years in eye surgery as a shock absorber to protect the retina, and has been proven effective in lubricating arthritic joints. 

Synvisc, for example, a FDA approved product used to treat osteoarthritis, works by injecting hyaluronic acid, or Hyaluronan, which acts as a shock absorber and lubricant. Dr Irving Raphael, a Syracuse, NY, orthopedist who specializes in sports medicine, explains that these injections coat the surface of the joint to decrease friction, which allows the joint to move more smoothly and cuts down pain.

When I prescribe it, he says, I simply tell my patients I’m going to give them a lube job. But, he warns, before prescribing it, he always asks if the patient is allergic to chicken or eggs. That’s because HA is extracted from chicken combs. The mohawk crown on a chicken’s head is washed, sliced and purified. 

Western Skeptics While hyaluronic acid has proven useful in orthopedics and opthalmology, many Western experts are skeptical that swallowing it in a pill could actually help prolong one’s life. I cannot today imagine any possible benefit, says Dr Endre Balazs, a leading expert on HA. The only way it acts, as far as I can see, as an anti-aging remedy, adds Raphael, is because if you’re not limping, and your joints feel better, you feel younger. 

But HA has been shown to have wound-healing and tissue-reconstruction applications, and some cosmetic companies tout it as an effective ingredient in moisturizers that can soften facial lines, leaving skin elastic and firm. One company even claims it may be the latest development in treating hair loss. And Komori, 80, who has adopted the local diet of very little meat and a lot of homegrown sticky starches, holds to his theory. “I feel very strongly that if I had not come here to Yuzuri Hara, I would not have lived this long and healthy a life,” he says. “I probably would have died from some adult disease. 

Komori also points to statistics that since Western-style processed food infiltrated the village a few years ago, heart disease has doubled. With youngsters being seduced by these products, what the Japs call an upside-down death pyramid has emerged, in which adults die before their elderly parents. “Although my children ate what I had been eating while they were young and lived here,” says a 91-year-old woman who has outlived two of her six children, when they moved away they chose to eat diff.



\3 Effects of Aging

It's no secret that our bodies change as we age. Some changes are obvious, while others are more subtle. Many people age comfortably and remain active, alert and vibrant throughout their lives. Their physiologic age may be quite younger than their chronological age. Others, however, may experience the effects of osteoporosis and osteoarthritis, which can gradually diminish their abilities to participate fully in activities. 

Knowing what to expect and taking steps to counterbalance the effects of aging can help you maintain a young spirit and an independent life. A healthy diet, regular exercise program and positive attitude can help delay the onset and slow the progression of many age-related changes. 

Aging muscles - As muscles age, they begin to shrink and lose mass. This is a natural process, but a sedentary lifestyle can accelerate it.  The number and size of muscle fibers also decrease. Thus, it takes muscles longer to respond in our 50s than they did in our 20s.  The water content of tendons, the cord-like tissues that attach muscles to bones, decreases as we age. This makes the tissues stiffer and less able to tolerate stress. 

Handgrip strength decreases, making it more difficult to accomplish routine activities such as opening a jar or turning a key.  The heart muscle becomes less able to propel large quantities of blood quickly to the body. We tire more quickly and take longer to recover.  The body’s metabolic rate (how quickly the body converts food into energy) slows. This can lead to obesity and an increase in "bad" cholesterol levels. 

Aging bones - Throughout life, bones constantly change through a process of absorption and formation called "remodeling." As we age, the balance between bone absorption and bone formation changes, resulting in a loss of bone tissue.  The mineral content of bones decreases, so that bones become less dense and more fragile. 

As bones lose mass, osteoporosis develops, affecting both women and men. In the spine, osteoporosis can lead to crush fractures of the vertebrae, resulting in a "dowager’s hump." Osteoporosis is also responsible for almost all hip fractures in older men and women. 

The chemistry of cartilage, which provides cushioning between bones, changes. With less water content, the cartilage becomes more susceptible to stress. As cartilage degenerates, arthritis can develop.  Ligaments, connective tissues between bones, become less elastic, reducing flexibility. 

Aging joints - Joint motion becomes more restricted and flexibility decreases with age because of changes in tendons and ligaments.  As the cushioning cartilage begins to break down from a lifetime of use, joints become inflamed and arthritic. 

Counteracting aging - Many of the changes in our musculoskeletal system result more from disuse than from simple aging. Fewer than 10 percent of Americans participate in regular exercise, and the most sedentary group is over age 50. 

Stretching is an excellent way to help maintain joint flexibility. Weight training can increase muscle mass and strength, enabling people to continue their daily routine activities without maximal exertion. Even moderate amounts of physical activity can reduce your risk of developing high blood pressure, heart disease and some forms of cancer. 

Long-term regular exercises may slow the loss of muscle mass and prevent age-associated increases in body fat. Exercise also helps maintain the body’s response time, as well as its ability to deliver and use oxygen efficiently. Just 30 minutes of moderate activity, incorporated into your daily routine, can provide health benefits. 

An exercise program doesn’t have to be strenuous to be effective. Walking, square dancing, swimming and bicycling are all recommended activities for maintaining fitness into old age. The 30 minutes of moderate activity can be broken up into shorter periods; you might spend 15 minutes working in the garden in the morning and 15 minutes walking in the afternoon. It all adds up. 

But if you’ve never attempted an exercise program before, be sure to see your doctor before starting one now.     Oct 00 

Keep Moving for Life - When asked what they consider to be major factors in maintaining a good quality of life as they grow older, people rank living independently and remaining active right at the top. But it is important to get active so that you can stay active. 

What can exercise do for me?  As you age, you lose muscle and bone mass and may develop problems in your muscles, joints and bones, such as back pain, osteoarthritis or osteoporosis. Regular exercise slows the loss of muscle mass, strengthens bones and reduces joint and muscle pain. In addition, mobility and balance are improved, which reduces the risk of falling and suffering a serious injury such as a hip fracture. 

Don't you need to exercise long and hard to get any benefits from physical activity? 

Scientists used to think that strenuous exercise was the only way to improve your health. However, new research suggests that just 30 minutes of moderate physical activity, such as a brisk walk or washing your car, provides most of the health benefits from exercise. The activity doesn't have to be too vigorous, in fact, moderate intensity is best, but even low-intensity activity is better than nothing. While some people may enjoy participating in a regularly-scheduled exercise class, others may find it easier to just increase their daily activities. 

The key is to find something that you enjoy doing and do it regularly.  go for a brisk walk  work in the yard  go for a bike ride  walk the fairways when you golf  wash and wax your car 

I'm getting older. It seems like it's too late to start exercising. Would I really benefit? 

It's never too late to start. Physical activity is especially important for older adults, and can help them live independently for as long as possible. A study of frail, wheelchair-bound nursing home residents in their 80s and 90s who participated in a weight lifting program showed marked improvement in their strength and overall functional ability. Staying active also lowers your risk of heart disease or heart attack, lowers blood pressure, controls diabetes and helps you maintain a healthy weight level. 

But I have a chronic medical condition. Won't physical activity make it worse? 

It's just the opposite-if you have a chronic condition affecting your muscles, joints or bones-lack of physical activity can make the condition worse, or at least make it more difficult to live with. Medical research shows that physical activity is both safe and beneficial for people with arthritis, osteoporosis and other chronic conditions of bones and joints. 

BACK PAIN - I suffer from back pain. Won't exercise make it worse?  You shouldn't exercise during an acute bout of back pain, but by strengthening the muscles of your stomach, hips and thighs, you can relieve chronic back pain and prevent your condition from getting worse. A balanced fitness program of regular physical activity and specific strengthening exercises is ideal. 

What should I do?  During times of acute back pain, hold off on strenuous exercise, but get up and move around. Prolonged bed rest and inactivity will delay your recovery. 

Stay in good physical condition by running, walking, swimming, bicycle riding or weight lifting. Use the correct lifting techniques to move objects.  Maintain proper body weight. 

OSTEOARTHRITIS  - I've been told I have "arthritis." What exactly does that mean?  While there are many types of arthritis, the most common form of this bone and joint condition is osteoarthritis. It is the leading cause of disability in people over the age of 55. Although the cause is unknown, the pain of osteoarthritis is caused by the deterioration of the cartilage and underlying bone in the joints. 

When I try to walk or do other exercises, and particularly when I go up and down stairs, I feel pain in my joints. I'm afraid more exercise will cause more damage. 

Just the opposite is true. Any type of exercise will strengthen joints and the surrounding muscles. It also will relieve joint stiffness and reduce pain. Inactivity can aggravate the problem because weak muscles around the joints can lead to joint instability. 

If one type of exercise causes pain, try another exercise. You might try swimming or walking in a pool until your muscles are strong enough to try walking on a firm surface. Start with short, frequent sessions of physical activity. Remember, exercise also can help control other conditions such as high blood pressure and diabetes. 

OSTEOPOROSIS - I have been told that I may have osteoporosis. How serious is this problem?  Osteoporosis is a major contributor of bone fractures in older people, particularly postmenopausal women. It is a major public health problem, affecting more than 200 million people worldwide and 25 million Americans. 

Because I have osteoporosis, shouldn't I avoid exercise to protect my bones and avoid a fracture? 

Weight-bearing exercises such as walking, jogging and weight lifting can stimulate bone growth and make your bones healthier. Regular exercise also will help you maintain good balance so that you are less likely to fall and suffer a disabling bone fracture. More than 300,000 people are hospitalized each year with hip fractures. 

What else can I do?   Stimulating bone growth and preventing bone loss through exercise should be part of your lifestyle because once you stop, the benefits begin to diminish in two weeks and disappear in two to eight months. Your doctor can help with a total plan for the treatment and prevention of osteoporosis, including calcium, meds and hormone replacement for older women. 

TOTAL JOINT REPLACEMENT - I have had a total hip replacement and have been told by my physician to be careful so I will not damage it. What kind of activities will not damage my prosthesis or total joint replacement?

While you are recovering, follow the graduated walking program and specific exercises prescribed by your orthopaedic surgeon or physical therapist to restore movement and strengthen the muscles and ligaments surrounding the prosthesis. 

After you are fully recovered, participate in daily activities such as walking, bicycling, swimming, golf, moderate hiking and ballroom dancing to maintain the strength and mobility of your new joint. 

Talk to your physician before engaging in activities such as jogging, skiing or tennis. 

Is it dangerous to exercise after having a total joint replacement?  Normal, healthy levels of activity will not damage your prosthesis or joint replacement. In fact, to take full advantage of the surgery, you must stay active for the rest of your life. If you aren't active, your muscles will weaken which will increase your risk of falling. Falls are a leading cause of repeat surgeries. 

TIPS ON STAYING FIT - Exercise makes you feel good. Regular exercise can reduce stress and give you a more positive outlook on life. The reason people exercise regularly is that "it makes you feel good." 

Moderate physical activity works. It's a myth that to be physically fit, you have to exercise hard for long periods of time. Experts agree that physical activity doesn't have to be vigorous to improve your health. The key is to feel your lungs, heart and muscles working harder, but not too hard. 

It all adds up. Physicians recommend at least 30 minutes of moderate physical activity daily, or on most days of the week. You don't need to be active for 30 minutes at a time. The 30 minutes can be broken up into shorter periods. It all adds up. 

Keep it fun and interesting. The activity could be walking, swimming, weight lifting, bicycling or golf. Housework, gardening, dancing-even playing with your grandchildren-count as physical activity. Select the activities you like. Do different activities on different days. One morning you might spend 15 minutes working in the garden, followed by a 15-minute walk in the afternoon. The next day you might play a round of golf and later swim a few laps in a pool. Keep it fun and interesting. 

DON'T FEAR PAIN - Many people with problems of swelling and stiffness of the bones, joints, tendons and other unspecified aches and pains avoid physical activity because they fear pain. 

You can expect to experience some muscle soreness when you start exercising, but it will disappear as you exercise regularly. Start out slowly, and if one activity hurts too much, switch to something else. Of course, stop what you're doing if you experience severe pain or swelling. 

Your orthopaedic surgeon or physical therapist can recommend exercises to help ease your discomfort. Focus on fitness utilizing varied, daily physical activities that you enjoy. 

Your orthopaedist is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves. 

This brochure has been prepared by the American Academy of Orthopaedic Surgeons and is intended to contain current information on the subject from recognized authorities. However, it does not present official policy of the Academy and its text should not be construed as excluding other acceptable viewpoints.

Exercise and Bone and Joint Conditions As we get older, our bodies change. Muscle size and strength decrease primarily due to inactivity. Bone mass and density decrease, increasing the susceptibility to fractures. Tendons and ligaments become less elastic, making it easy to get overuse injuries. Joint inflammation and cartilage degeneration often occur due to arthritis. 

Thirty minutes of physical activity a day can help individuals feel good, and prevent some medical conditions. Even individuals with chronic conditions such as osteoarthritis and osteoporosis can benefit from a balanced fitness program. 

Here are some exercise tips developed by the American Academy of Orthopaedic Surgeons for individuals with osteoarthritis, low back pain, osteoporosis or total joint replacement. 

Osteoarthritis - More than 42 million Americans have some form of arthritis. There are two major types of arthritis-osteoarthritis and rheumatoid arthritis. Often, weight-bearing joints such as the knee, hip and spine are involved in osteoarthritis. Rheumatoid arthritis commonly affects joints in the hands, wrist, feet and ankles. 

Exercise is very important for individuals with arthritis. Exercise helps keep the joints flexible, the muscles around the joints strong, bone and cartilage tissue strong and healthy; and reduces pain. 

Individuals with osteoarthritis should: engage in a balanced fitness program that includes walking, swimming, cycling and stretching exercises.  avoid exercises that place excessive stress on the joints like aerobic workouts, running or competitive sports activities 

Low Back Pain - Almost 14 million persons a year see a physician because of back pain. Most often, back pain is caused by excessive strain of the back muscles and ligaments. Lifting improperly or a sudden twisting movement can result in low back pain. Other acquired conditions like infections or arthritis also can cause pain. 

Exercise is a common treatment for people experiencing low back pain. Orthopaedic surgeons usually prescribe exercises that increase muscle strength to better support the spine as well as improve flexibility and function. 

Individuals with low back pain should: perform daily stretching exercises. Engage in a more active exercise program once the initial pain subsides that includes walking, swimming, bicycling and strength training with light weights 

Osteoporosis is a major health problem affecting 28 million Americans, and contributing to an estimated 1.5 million bone fractures each year. 

Osteoporosis is a condition in which the bones weaken and lose density, becoming thin, brittle and susceptible to fractures. It is caused by the natural aging process because as people get older, they lose bone mass. 

Exercise can help slow the progress of osteoporosis and build strong bone. Orthopaedic surgeons believe that a program of moderate, regular exercise (three to four times a week) is effective in the prevention and management of osteoporosis. 

To prevent osteoporosis, individuals should: participate in weight-bearing exercises like walking, hiking, stair climbing, dancing, racquet sports and treadmill exercises.  Engage in strength training exercises with light weights. 

Total joint replacement - More than 442,000 total joint replacement procedures are performed each year by orthopaedic surgeons in the U.S. The most frequent reason for performing a total joint replacement is to relieve the pain and disability caused by severe arthritis. 

Most total joint replacements involve hip and knee joints, however, total joint replacement also can be performed on joints in the ankle, shoulder, fingers and elbow. 

Individuals with a total joint replacement still can lead active lifestyles. Exercise not only is important in the recovery process, but also in the years following the surgery. A proper exercise program can help restore mobility and strength in the joint. 

Individuals with a total joint replacement should: avoid activities that place repeated stress on the replacement such as running, jogging or skiing.  Engage in activities that do not place excessive stress on the replacement like swimming, bicycling, golf and doubles tennis. Seek medical advice before beginning any physical activity because some restrictions may be recommended.  http://www.nlm.nih.gov/medlineplus/spinaldiseases.html


\4 the future

The life expectancy calculator is a simple calc and is based on a specific mortality table used by actuaries for retirement planning purposes. The mortality table is called GAM 83 and is based on ins grp annuity experience from the 1970s. The table only varies by sex and by age. Actuaries use this table to help determine how much a pension plan should hold for retired individuals. 

The calculation uses the probabilities of living from the table for a given age and sex and then determines how long that individual is expected to live. The table will not be accurate for any given individual but is correct when considering large groups of people. Any given individual will have a 50% chance of living longer than the life expectancy and a 50% chance of dying earlier than the life expectancy. On average, however, the table will produce the correct value. 

Of course, (as many users have pointed out) individual health and longevity circumstances vary. This calculator is not supposed to calculate your exact time of death but merely give you a rough estimation of how long you can expect to live in order to help you in the retirement planning process. 

The calculator is written in Java with an html interface. The Java program is running server side and is based on my Actuarial Kit. The pgm was written by Scott Parkinson and Joshua Levy. I'm expected to live to be 82 (3/2001).
  Methodology and Assumptions for Life Expectancy Calculations at: www.retireweb.com/death.html

 A Pill to Extend Life? Don't Dismiss the Notion Too Quickly

Offering a sharp insight into the nature of aging, biologists report today that they have shown precisely why a calorically restricted diet prolongs life span, at least in a lower organism. The finding, should it prove true of people too, would open the possibility of developing drugs to mimic the effects and gain the remarkable benefits of the draconian low-calorie diet.

Laboratory rats and mice live up to 40 percent longer than usual when fed a diet that has at least 30 percent fewer calories than they would usually eat though otherwise contains all necessary vitamins and nutrients. The animals are free of age-related disease and appear healthy in every respect except that they are generally less fertile.

Studies with rhesus monkeys, which usually live around 25 years, have not been in progress for long enough to say if caloric restriction is likely to benefit primates like monkeys and people, though initial signs are positive.

Even if caloric restriction does prove to prolong human life, very few people could adhere to such a meager diet. Other means, ideally a simple pill, might capture the benefits. But drugs require a target to act on, and the mechanism by which caloric restriction affects life span has long been a mystery.

The issue now seems to have been settled at least in yeast, a widely studied laboratory organism whose metabolism is similar to that of animals in many fundamental ways.

Dr. Leonard Guarente and colleagues at the Massachusetts Institute of Technology report in today's issue of Science that caloric restriction extends life span in yeast because it interacts with a gene that controls the activity of DNA, the genetic material.

The gene is known as SIR2, for silent information regulator No. 2, and its product, the SIR2 protein, silences genes by making the material that clads the DNA wrap more tightly, thus denying a cell access to the underlying genes.

The SIR2 gene has a direct effect on the yeast cell's longevity; Dr. Guarente previously found that yeast cells in which the gene had been disrupted lived shorter lives than usual, while those given an extra copy of SIR2 lived longer.

Gene silencing is probably of great importance to the integrity of a cell because to have the wrong genes activated could derange a cell's function. Dr. Guarente believes that inefficient silencing in cells could explain many of the infirmities of age.

He and colleagues have now found that caloric restriction appears to work through the SIR2 gene pathway. Yeast cells grown with very little of their food, sugar in the form of glucose, lived longer than normal, but not if their SIR2 gene was disrupted.

The reason seems to be that both the cell's glucose metabolism system, and the protein made by the SIR2 gene, compete for the same chemical, a substance known as NAD. The SIR2 protein cannot perform its silencing duties unless it has NAD to help it, but when the cell is busily converting glucose to energy, there is less NAD available for the SIR2 protein.

Dr. Guarente's next project is to see if his findings in yeast are also true of higher organisms. Both mice and people have their own versions of the SIR2 gene, and the protein requires NAD to function.

The mechanism makes evolutionary sense, Dr. Guarente said, because when food is scarce an organism's best strategy is to postpone reproduction and wait until conditions improve. So a gene like SIR2 that linked greater longevity to lower calorie intake would be highly favored by the forces of natural selection.

Dr. Tomas A. Prolla, a geneticist who studies aging at the University of Wisconsin, said Dr. Guarente's report was the first to link the life extension effects of caloric restriction to a single gene.

"If the find can be translated to animals, it will be veryiimportant," Dr. Prolla said, because it would provide "a starting point in the design of drugs which would have a broad effect on human health, including cancer."

The 40% life extension seen under caloric restriction could be just a hint of what would be possible once the underlying mechanism is understood. "I don't think a 30-40% range should be considered as some kind of max," Dr. Prolla said.

Dr George S. Roth of the National Institute of Aging, who has been conducting a calorie restriction study on rhesus monkeys since 1987, said there had been fewer deaths so far among the dieting monkeys, which receive 30 percent fewer calories, than among a comparison group that feeds normally.

The mortality difference is not yet statistically significant, Dr. Roth said, but the restricted monkeys have already developed metabolic patterns suggesting they will prove more resistant to diabetes and heart disease. 

There is an interesting difference of opinion on the subject of aging between evolutionary biologists, who believe for strong theoretical reasons that aging must be influenced by many different genes, and molecular biologists who have found they can extend the life of laboratory organisms by altering single genes.

Reflecting this difference, Dr. Michael Rose, an evolutionary biologist at the University of California at Irvine, said that the work with yeast was "really nice and elegant" but that Dr. Guarente was mistaken in arguing that gene silencing or any other single mechanism of aging was likely to be universal. 

Dr. Guarente acknowledged that many genes might be involved in aging. But there is likely to be a single major genetic pathway, he said, in the form of a mechanism to slow aging in response to food scarcity, because any such mechanism would be heavily favored by the forces of natural selection. 

--------------------------------------------------------- Experts Discuss Life Expectancy By THE AP Feb 19 2001.
  SAN FRANCISCO -- Human life expectancy has increased by three decades since 1900 and may reach 85 for babies born in this century, but that may be near the upper limit unless science finds ways to dramatically slow the aging process, some researchers said Sunday.

Claims by some scientists that humans in this century will have a life expectancy of 100 or even 120 are not realistic and not supported by the trends measuring the rates of death, said S. Jay Olshansky of the University of Illinois, Chicago.

"We anticipate that many people here today will live long enough to witness a life expectancy of 85 years, but everybody alive today will be long dead before a life expectancy of 100 is achieved, if ever," said Olshansky. The researcher was the head of a panel of experts that on Sunday analyzed trends in human life expectancy at the national meeting of the American Association for the Advancement of Science.

Olshansky said there are no ``magic potions, hormones, antioxidants, forms of genetic engineering or biomedical technologies that exist today that would permit a life expectancy of 120 or 150 years as some people have claimed.''

Leonard Hayflick, an expert on aging at the University of California, San Francisco, denounced what he called ``outrageous claims'' by some scientists that humans are capable to living well past 100 years.

``Superlongevity,'' he said ``is simply not possible.''

Hayflick said that even if the most common causes of death -- cancer, heart disease and stroke -- were eliminated, "the increase in life expectancy would be no more than 15 years." With those death causes gone, he said, the true cause of death would be revealed: the aging process.

Aging, he said, is a decline on a molecular level that makes people ``increasingly vulnerable to disease'' and that this process is not receiving much research attention. Instead, most aging research, said Hayflick, concentrates on the age-related diseases that can be easily identified, such as heart attack, stroke, cancer and Alzheimer's disease.

Nature designed humans to peak physically at about age 20, to assure reproduction and survival of the species, he said. After that, humans ``coast for another four to five decades'' and it is the length of this coast that determines longevity

Kaare Christensen of the Univ of Denmark said the future may not be as bleak as Olshansky and Hayflick suggest. He said studies in Sweden, where every citizen has been listed on health roles for about 200 yrs, show that the upper limit for the oldest of the old at the age of death is still going up. A study pub last year showed that the oldest person to die in that country in 1999 was 108.

Christensen said that the age at death of the oldest old continues to increase ``and the is no evidence that we are pushing up against the limits.''

Jeanne Calment, a Frenchwoman, died in 1997 at the oldest documental age of 122.45 years. But measuring the maximum age achieved by a remarkable individual does not directly correspond to life expectancy, which is a measure of how long half of the population born at a specific time can expect to live, said other experts.

Olshansky said the developed nations of the world have already enjoyed the most dramatic improvement in life expectancy in human history.

An American female born in 1900 had a life expectancy of 48.9 years. By 1995, life expectancy for a newborn girl was 79. And there continues to be small gains. Death rates from 1985 to 1995 declined by 1.5 percent in France, 1.2 percent in Japan and 0.4 percent in the U.S., said Olshansky.

Projecting these trends forward, he said, would give a combined male and female life expectancy of 85 years in France by 2033 and in Japan in 2035. Americans would not achieve a life expectancy of 85 until 2182, Olshansky said.

The Social Security Administration has forecast that U.S. life expectancy at birth will rise to 79.3 years for males and 83.9 years for females by 2070. But to achieve this, said Olshansky, would require a faster decline in death rates for all ages.

For instance, to achieve the Social Security estimate, he said, would require that death rates for the population aged birth to 30 would have to approach zero. This, said Olshansky, is ``biologically implausible and over optimistic.''


Life span. 32,000 centenarians in 1982, 61,000 in 1998, and 500,000 by 2050. People with bad health habits that they will not or cannot abandon often make excuses: "What's the point of living longer -- you'll only spend more years in a nursing home?" or "A healthy life really isn't any longer, it just seems that way."

LIVING LONGER, LIVING BETTER.
 A study of University of Pennsylvania graduates, classes of 1939 and 1940, indicates that those who practice healthy habits saay free of disabilities longer. Class members were divided into low, moderate and high risk groups based on weight, exercise and use of tobacco. Those groups then were rated on a disability index based on eight basic tasks: dressing and grooming, arising, eating, walking, bathing and other hygiene, reaching, gripping and executing basic chores. A score of 0.1 indicates some difficulty in performing one of the tasks. A score of 1.0 means some difficulty performing all eight tasks. And the maximum score of 3.0 indicates inability to perform all eight tasks.
 Sources: Dr. Anthony J. Vita and Dr. Raymond R. Balise
 Perhaps the saddest excuse of all dates back to 1964 when the Surgeon General issued the first report on smoking and health. Diehard smokers told me, "By the time I get lung cancer, they'll know how to cure it." If only that had happened. But 34 years later we are hardly closer to curing lung cancer than we were then. The fact is none of these excuses hold up under the scrutiny of sound medical research, and a recently published study of more than 1,700 men and women followed for 32 years puts the lie to them all. The study, published in April in The New England Journal of Medicine, clearly showed that people with healthier habits not only live longer, they live better, experiencing only half as much chronic disability as their less-prudent age mates. The findings strongly suggest that vitality into one's later years is less a matter of genes and more a question of how a person chooses to live. Those who smoked the least, stayed trim and exercised regularly not only lived longer but were less likely to develop disabilities. Even among participants who died, the low-risk people had shorter periods of disability before dying.
 Changing Mortality Curve n 1980, Dr. James Fries, professor of medicine at Stanford University, published a provocative article suggesting that preventive health practices would keep Americans healthier longer and change the shape of the nation's disability and death curve from one that resembles a water slide to one that looks more like a cliff. According to his "compression of morbidity" hypothesis, most Americans, instead of experiencing a more-or-less steady rate of increasing disability and deaths starting at mid-life, could live reasonably well into their 80's, before they begin to die at an accelerated rate. To put it another way, if people could be persuaded to choose more prudent health habits, the majority would reach their ninth decade in good health and then die after, at most, a relatively brief period of illness.
 Vitality in old age may have less to do with genes than with how you live.
 But some skeptics challenged Fries, suggesting instead that practicing good health habits, while likely to add years to life, would also swell the number of years during which people are beset by chronic illness and disability. If true, critics said, this would further overwhelm an already overburdened system struggling to care for millions of elderly Americans with costly, debilitating, lingering health problems. Healthy Habits Do Pay ow, nearly two decades after Fries's proposal, he and his colleagues have data that dispute the naysayers. According to their new findings, living healthfully would not only add years to life, it would also add life to years, keeping people well and able to enjoy life far longer than they otherwise might have. Although the participants' average age was only 75 at the last assessment, there is every indication that those with healthy habits will on average remain in better health however long they live. Those whose habits put them at lowest risk for health problems delayed the average age at which they developed even minimal disability by nearly seven years -- to age 73 as against age 66 for those at highest risk. The researchers tracked 1,741 men and women who graduated from the University of Pennsylvania in 1939 and 1940. These alumni were surveyed by other researchers at the time of graduation and again in 1962, 1976 and 1980 before the Stanford team took over and reassessed their health habits and health status annually for seven years starting in 1986.

Participants were classified as being at high, moderate or low risk based on three modifiable factors known to contribute to poor health: cigarette smoking, excess weight and inactivity. At every assessment -- even when the participants were only about 43 years old -- those at highest risk were more likely to report disabilities than those at moderate risk, who in turn had more disabilities than those at low risk. The authors emphasize that for the overwhelming majority these risk factors are matters of personal choice. But it is all too obvious that a growing number are making the wrong choices. Although tens of millions of adults have quit smoking in the last 34 years, we now face the chilling fact that as many as 40 percent of students in some high schools are smoking. The tobacco industry has been particularly successful in hooking teen-age girls and young blacks on this noxious weed. And if you think young Americans smoke too much, in many European countries it is hard to find any young person without a cigarette. Obesity, too, is a growing concern. Americans on the whole are fatter now than at any time in our history. People tend to blame the ready availability of high-calorie foods and the constant temptation to eat too much, especially too much fatty, sugary foods. Few seem to have the will to resist overindulging. But the food supply and eating habits are not the only culprits. Inactivity has a major, deleterious influence on the weight of Americans. Having created a society replete with labor-saving devices, we failed to compensate adequately for our relative inactivity by building more exercise into our daily routines and leisure time. Only about one American in five gets enough exercise to keep weight down and health up. And there is virtually no physical activity in the lives of 60 percent of Americans, whose exercise consists of little more than pressing a finger to the television remote. Yet, those who exercise regularly weigh less and are better able to achieve and maintain weight loss. Thus, in addition to its direct health benefits, for example, in preventing cardiovascular diseases and cancer, exercise can help control weight. Other factors not assessed in the Fries study also influence health. But the people who stayed trim and exercised, in all likelihood, regularly ate more healthfully as well. I think you get the point: at any stage of life, it pays to pay attention to preventive health practices. Good health and longevity are largely in your hands. PERSONAL HEALTH - Adding Years to Life and Life to Years
 Discovering What It Takes to Live to 100

Mr Thomas T.Perls leaned in close and spoke gently, locking his eyes into Mary Lavigne's. He had pulled his chair to within two feet of the petite, white-haired woman in her sunny living room in Lancaster, Mass. "When were you born?" he asked, amplifying his voice. "What's your birthday?" Miss Lavigne pulled back an inch. Unlike the other two women Dr. Perls had interviewed earlier in the day, she can hear just fine. "Sep 28 1899," she said. "You've been in three centuries!" Dr. Perls said. "It's amazing. Do you think it's amazing?"

"Yeah, I'm thankful. I'm very thankful that I'm able to take care of myself," Miss Lavigne (pronounced luh-VEEN) said with her Massachusetts accent. She wore a beige and navy striped golf shirt, and she sat perfectly straight, her delicate hands folded on her lap. "Do you have great- great-grandchildren?" Dr Perls asked. "I never married," Miss Lavigne said with practiced determination. "I didn't want to get into it."

They spoke for several minutes about her early childhood in Quebec, her memory of the first automobiles and of hearing President William Howard Taft give a speech in Westbrook, Mass., in 1911. Then Dr. Perls, a geriatrician at Beth Israel Deaconess Medical Center, in Boston, and an assistant professor of medicine at Harvard Medical School, explained why he wanted to know so much about her. He wanted her to be part of his nationwide study of centenarians. 

If she agreed tocparticipate, he would ask her to provide a DNA sample, to take a psychological test to measure her mental acuity (though it is obviously strong) and to consider donating her brain for research. Also, he would want to interview her closest living relatives. "Who are the nephews or nieces most interested in your affairs?" Dr. Perls probed.

"Well, they're all interested in my affairs," she replied with a laugh. "They come to visit and they say: `I want this and I want that. I want this and I want that.' " Like so many of the hundreds of centenarians Dr Perls has interviewed in the last six years, Miss Lavigne left him and his associate, Dr. Margery Hutter Silver, a neuropsy- chologist who is also at Beth Israel and Harvard, shaking their heads over her clear thinking, her near-perfect health and her alert sense of humor.

"You don't realize it, because she doesn't act like it," Dr. Perls said, "but she is also legally blind." Even Miss Lavigne's denunciation of marriage sounded familiar. About 14 percent of the women Dr. Perls has studied have stayed single for their 100 years. Could that be because unmarried women lead relatively unstressful lives? Maybe, Dr. Perls said. "Or maybe the fact that they are able to live independently means that they are able to manage stress better than the average person," he said.

In contrast, the centenarian men in the study group are all married, or have been. But there are more than five times as many women as men.

In nine years, Dr. Perls and his research staff have collected health data on some 1,500 centenarians. And the work has led him to a series of discoveries about the very old. They are healthier than anyone ever thought they were, first of all. They avoid the most devastating diseases of old age until the last few years of their lives. And almost all of them seem to be exceptionally good at managing stress and getting along with people.

Even those unmarried women are never alone. "They're full of good humor and gregarious," Dr. Perls said. "They're basically very happy, optimistic people. You look at a person like Mary Lavigne and you see she has people taking her to lunch, people looking after her, because she's so nice." Most notably, Dr Perls and colleagues have recently found, centenarians seem to carry a small handful of genes that enable them to live to 100 plus.

In Aug 01 Dr Perls and his colleagues including two molecular geneticists, Dr. Louis M. Kunkel and Dr Annibale A. Puca of Children's Hosp in Boston announced the results of a study of centenarians with very old siblings. After examining their DNA, the researchers determined that a longevity-enabling gene might exist in a certain small stretch of chromosome No. 4, one of the 23 pairs of human chromosomes.

The researchers hope that Centagenetix, the Boston-based company they founded, will home in on that gene before next summer. Ultimately, the company hopes to identify a number of longevity genes, figure out how they work and create drugs that mimic their actions.

Dr. Perls does not think that genes alone keep people alive for so long. Most of his subjects have healthy life patterns. He has met some who live to a ripe old age even while smoking cigarettes or eating high-fat foods, but, he said, "These are the ones who you would suppose really have some spectacular genetic stuff going on." Still, a great majority of his subjects never smoked. Few drink to excess. And though no particular diet seems to ensure long life, obesity is never part of the picture.

But Dr. Perls is adamant that good habits alone cannot get a person to the century mark. He said: "If you do absolutely everything right — you're Jack La Lanne, you've got the perfect diet, you're exercising for a really long time, you're happy-go- lucky and incredibly nice, and you're thin, I would say that without the appropriate genetic variations, it's still extremely difficult to get to 100."

The health histories of Dr. Perls's centenarians suggest that there are three kinds of people who achieve extreme old age. Forty percent are "survivors," those who live with chronic diseases for decades, beginning in their 60's and 70's. Another 40 percent are "delayers," who put off illness until their mid-80's. And the last 20 percent are "escapers" — people who avoid all age-related diseases until they are over 100.

Until very recently, centenarians were not numerous enough for study. Today, about 50,000 Americans are 100 or older, up from almost none at the turn of the previous century. By 2050, as many as 800,000 to one million Americans may still be alive at 100 or older, with improving health care practices. 

Dr. Perls became fascinated by the extremely old when he was a geriatrics fellow at Harvard, taking his turn working at the Hebrew Rehabilitation Center for Aging in Boston. That was in the 1970's, and like other physicians at the time, he assumed that his centenarian patients would be the sickest. In fact, he had trouble finding them in their rooms. "One was playing the piano for everybody," Dr. Perls said. "Another one was a tailor, mending people's clothes."

In 1993, he began the New England Centenarian Study, which at first focused on eight Massachusetts towns. One of the first things that he and Dr. Silver found was that senility was not an inevitable accompaniment to old age. About 70 percent of the centenarian men, but only 30 percent of the women, were still clear-headed; the explanation is not known, but the researchers suspect women with dementia are more likely to survive than men with the condition. 

Dr. Perls also found a surprising statistic about the centenarian women who were mothers. One in five of them had had at least one child after the age of 40. In the general population, only about 5 percent of mothers give birth that late.

"In other words, if you have a child after the age of 40, you have about a four and a half times greater than average chance of going on to 100," Dr. Perls said. "It isn't just the act of having a child, we don't think. But late motherhood is a marker." It shows that the entire body is aging slowly, he said.

The more centenarians Dr. Perls met over the years, the more obvious it seemed that longevity could be inherited. He often recalls the day he spotted a photograph in The Patriot Ledger in Quincy, Mass., of a man celebrating his 108th birthday with his 103-year-old sister.

The two of them turned out to have had four siblings who lived past 100, plus another sister, still living at 97. Among these siblings' first cousins were seven centenarians and 14 others who lived to be at least 90. Two other families among his subjects included similarly large collections of extremely old people. 

Dr. Howard Fillit, director of the Institute for the Study of Aging, in New York, said the age of Dr. Perls's subjects had been the key to his discoveries. "It was Tom's great insight to recognize the value of studying families with large numbers of 100-year-old people," Dr. Fillit said.

By 1998, Dr. Perls had accumulated enough data to demonstrate that a person with a centenarian brother or sister was four and a half times as likely as the average person to live to be at least 91. This year, he has refined the statistics further: male siblings of centenarians have a chance 17 times as great as the average man's of living to 100. And female siblings are eight times as likely to reach 100.

On a walk through the Harvard Medical School campus four years ago, Dr Perls described his centenarian families to Dr Kunkel, the molecular geneticist. "We went back to my office and drew out the pedigree," Dr. Kunkel said. "To me, it was clearly genetic. I was pretty confident that if we looked for a gene, we would get something intere- sting." Ultimately, Dr Kunkel and Dr Puca examined the chromosomes of 303 people in 137 families. At least one sibling in each family was 98 or older; the others were at least 90.

In those families, a stretch of DNA on Chromosome 4 stood out; another stretch, on Chromosome 2 was also a candidate, though not as strong. Now, Centagenetix will try to replicate the study with more subjects, and zero in on the gene or genes in those sites that may affect life span. Dr Perls says he will not be surprised if the gene they find somehow accomplishes the twin goals of slowing the aging process and protecting against disease.

One way such genes may operate, Dr. Perls said, is by limiting the activity of free radicals, which are unpaired electrons that cause corrosive damage to tissues throughout the body. Studies on laboratory creatures — mice, worms, yeast and fruit flies — have shown that certain genes can shield against free radical damage and prolong life span.

"We already know that free radical damage has an important pathogenic role in heart disease and stroke," Dr. Perls said, "and it may also play an important role in Alzheimer's disease. There's been pretty good research showing that it plays an important role in aging."

Though the gene study has clearly taken center stage, Dr. Perls's work with centenarians has raised many other questions that he hopes to investigate. For example, he said, he would like to study the theory that it may be possible for people to build a "cognitive reserve" that enables them to avoid dementia in old age. He described a 103-year-old man who, in psychological tests, showed no signs of senility. Yet after the man's death, when his brain was examined in autopsy, it was found to be laced with the tangles of dead cells that characterize Alzheimer's. Perhaps the man had been able to strengthen other parts of his brain — to build a cognitive reserve — to get around his disease.

Dr. Perls would also like to learn more about the psychology of longevity — how attributes like spirituality, optimism, humor, financial security, stress management and friendships help people live to be 100. "It would be very interesting to find out, no matter how good your genes are, what environmental things are a must," he said.

What are the chances that Dr. Perls himself, now 41, has some genetic propensity for longevity? It is a question he has definitely thought of. The good news is that his great- great-grandmother lived to 102. His mother is in excellent health at 78. Signs are even better for his wife, who gave birth to their youngest of three children when she was 41.

But whatever his genes have in store, Dr. Perls intends to do what he can to stretch their potential. In the past year, he has dropped 30 pounds from his 5-foot-11 frame, reaching a trim 170, by taking up spinning classes and coaching his 9-year-old's soccer team.

The way to lengthen your life, Dr. Perls pointed out, is to add healthy years. "Even if we can't live to be centenarians," he said, "we can all be centenarianlike, in that we can try to compress the time that we're sick toward the very end of our lives."


\5 social aids

Crises of old age

There are a number of problems of daily life that cause crises in old age: Social transplantation - removal from the homes they have lived in for years  Retirement  Bereavement  Loss of abilities (due to illness or aging changes)  Death and dying.  In general, older people who are less affected by these crises are those with:

Religious faith  Social desirability and active social life  Decreased obligations  Fewer stressful events  Increased freedom  A spouse.  Marital status Surveys in the 1970s and 1980s indicated that, because women tend to live for several years longer than men:

79% of older men and only 39% of older women are married  More than 50% of older women are widowed  In those aged 85+, almost half the men are married, compared with 10% of the women.  In other words, because women live longer than men do, they are far more likely than men to be living alone in older age. So they are more likely to suffer from:

Loneliness, Isolation, The crises of old age. 
 Women live longer than men do, so they are far more likely than men to be living alone in older age 

Promotion of social functioning in older people who live at home A number of community-based measures can promote social functioning in older people who live at home, and reduce the sense of isolation and loneliness in those who live alone.  

Social functioning can be encouraged by a number of measures. (adapted from the AGS) A SUPPORTIVE ENVIRONMENT  Seating in community areas  Easy-access public toilets  Effective community policing  Street lighting  Home security and alarm provision  Personal attack alarms  Victim support schemes  TRANSPORT AND ACCESS  Access to public buildings  Ramped curbs  Convenient public transport  Dial-a-lift and mobility services  LEISURE  Mobile libraries  Large print and audiobooks  Information services of relevance  Opportunities for physical activity  CONTINUING EDUCATION  Pre-retirement education courses  Self-education groups  University of the Third Age 

Health promotion strategies for those who live at home Substandard housing is a key issue. It leads to: Illness from dampness  Hypothermia from inadequate heating and draughts  Problems of access, and being housebound, from inadequate design  Falls and accidents from problems of layout  Frustration and anxiety from the need for repairs.  So effective health promotion strategies include:

Home care and repair schemes  Gardening chore workers  Heating and insulation strategies  The installation of aids and appliances  Personal and domestic care services  Community alarm systems.  The problem with effective health promotion strategies is their cost. Private services are probably more reliable, more quickly obtained and more flexible than government ones. But many people may not be able to afford them. The person who can no longer live at home despite health promotion strategies or other help may need caregiving.

Effective health promotion strategies include those which improve the environment in which the older person is living 

When older people cannot cope alone There are a number of options available to the older person who cannot cope alone. Apart from caregiving, these always involve at least some element of formal healthcare support, and so are considered in more detail in the section called Basics of care:

Caregivers  Community based care  Long-term care (non-institutional)  Nursing home care  Hospitalization.  Caregivers Family caregivers:

Provide at least 80% of the care received by patients in the community  Are mostly women, either wives or daughters  Mostly live in the same household as the patient  Must spend 4-8 hours per day on care, generally for 1-4 years.  The advantages of informal caregivers are:

Shared life history with the patient  Continuity of care  May be highly committed  Flexible, not constrained by job descriptions.  But these informal caregivers have:

Little or no training  No extra practical help/support  No financial help  Lack of recognition  May have previously not had a particularly good relationship with the patient  May spend years caring for a person without any days off for themselves  May be old themselves and have their own health problems  May not recognize (or feel comfortable admitting) the effect on their mental and physical health of caring.  So the stress of caregiving can prove burdensome. The caregiver’s physical and emotional health may be affected. Half of caregivers:

Experience symptoms of depression and stress  Suffer a worsening of their own health problems.  Some people are more able to cope with caring than others. A few people will find it hard to care for someone with only very mild impairments, and their stress is very real, even though out of proportion to their efforts. Others continue to care for their loved ones through years of very serious impairment. Some caregivers abuse the patients, or are irritable with them, while others, usually those looking after severe Alzheimer’s, may be abused by the patient. Whatever the caregiver or the patient is like, each sometimes needs a break from the other. This can be achieved by:

Temporary admission of the patient to hospital  Support networks and clubs  Day centers  “In-sitters”, e.g. during the day to allow the person to go out, or at night so that they can get an adequate amount of sleep.  Unfortunately some people are resistant to help and support, and these are usually the people who are most likely to find it difficult to cope with any level of caregiving. 

Some people are resistant to help and support, and these are usually the people who are most likely to find it difficult to cope with any level of caregiving

Vol 11, Number 1 Spring 1999 Designing Universally for Older Adults by Lawrence H. Trachtman, MS People expect the world to adapt to their needs rather than the other way around. Yet in order to make the world more user-friendly, it must be responsive to the needs of diverse users. Designers of specialized products and environments have typically relied on their own insights, personal experiences and interactions to develop new designs for older people and people with disabilities, often to the detriment of intended users.

Universal design is the design of products and environments that are usable, to the greatest extent possible, by everyone regardless of age or ability. By definition, it is an idea important to every person who, at some point in life, may experience limitations due to age, illness or injury. 

The growing proportion of elders in America, combined with medical advances in the treatment of chronic disability, assures a growing population of individuals who will experience limitations in access and product use. By early in the next century, all baby boomers will be age 55 or older. Many will experience loss of function, affecting their daily lives. The greatest concern among older adults is retaining the ability to live independently, or "age in place."

Principles to Design By - In recent years, the research community has learned a great deal about the theory and practice of universal design. Drawing on this knowledge base, The Center for Universal Design coordinated the development of the Principles of Universal Design as a result of a research and demonstration project funded by the National Institute on Disability and Rehabilitation Research (NIDRR).

Based on their experiences, a team of researchers from across both the country and design disciplines developed and reviewed the following seven Principles of Universal Design:

1. Equitable Use - The design is useful and marketable to people with diverse disabilities.

2. Flexibility in Use -  The design accommodates a wide range of individual preferences and abilities.

3. Simple and Intuitive Use - Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills or current concentration level.

4. Perceptible Info - The design communicates necessary information to the user, regardless of ambient conditions or the user’s sensory abilities.

5. Tolerance for Error - The design minimizes hazards and the adverse consequences of accidental or unintended actions. A motion detector/rocker light switch is especially useful for bathrooms, garages, hallways, etc. 

6. Low Physical Effort - The design can be used efficiently and comfortably, and with a minimum of fatigue.

7. Size and Space for Approach and Use - Appropriate size and space is provided for approach, reach, manipulation and use regardless of user’s body size, posture or mobility.

The Principles are generic; they are not specific to any type of disability or design. They can lead designers to create universally usable environments and consumer products. The examples below highlight how the Principles can help to frame designs that create safe and inclusive environments for older persons and their families.

• Stepless entrances are easier for all people, whether using a wheelchair or mobility aid, pushing a shopping cart or moving furniture. Side lights at doorways allow people on both sides to see who is coming. This feature is convenient if you are tall or seated, and much easier to use than a peephole. (Equitable Use)

• Careful selection of switches and controls can greatly improve environmental interactions for older adults. Soft-touch or rocker switches are easier to locate and turn on or off than traditional switches when your hands are full. Motion detector lights improve safety when entering a dark room. Remote controls for lighting or heating and cooling systems, along with large contrasting displays, benefit anyone who has tried to find a light switch or adjust the thermostat at night. (Simple and Intuitive Use)

• Contrasting surfaces such as the floor and trim, treads and risers on stairs, and at edges of kitchen counter tops improve safety and usability for persons with visual limitations or children learning their way around. (Perceptible Information)

• Pressure balanced anti-scald valves in tubs and showers prevent burns by people who cannot move out of the way if the water temperature or pressure suddenly changes. (Tolerance for Error)

There are, of course, other examples of how the Principles can help evaluate design solutions against user needs. Still, we must remember that universal design is a continuum of user-based, good design. Although somewhat an unachievable goal (i.e., one design for everyone), considering universal design principles early on can help alleviate complex and costly redesign at a later time or when circumstances change. This does make sense for everyone. 
\6 social consider

State institutions to aid the elderly have existed in varying degrees since the time of the ancient Roman Empire. England in 1601 enacted the Poor Law, which recognized the state's responsibility to the aged, although programs were carried out by local church parishes. An amendment to this law in 1834 instituted workhouses for the poor and aged, and in 1925 England introduced social insurance for the aged regulated by statistical evaluations. In 1940 programs for the aged came under England's welfare state system. In the 1880s Otto von Bismarck in Germany introduced old-age pensions whose model was followed by most other western European countries. Today more than 100 nations have some form of social security program for the aged. The United States was one of the last countries to institute such programs. Not until the Social Security Act of 1935 was formulated to relieve hardships caused by the Great Depression were the elderly granted old-age pensions. For the most part, these state programs, while alleviating some burdens of aging, still do not bring older people to a level of income comparable to that of younger people. Physiological effects. The physiological effects of aging differ widely among individuals. However, hronic ailments, especially aches and pains, are more prevalent than acute ailments, requiring older people to spend more time and money for medical problems than younger people. The rising cost of medical care has caused a growing concern among older people and societies, in general resulting in constant reevaluation and reform of institutions and programs designed to aid the elderly with these expenses.
 In ancient Rome and medieval Europe the average life span is estimated to have been between 20 and 30 years. Life expectancy today has expanded in historically unprecedented proportions, greatly increasing the numbers of people who survive over the age of 65. Therefore, the instances of medical problems associated with aging, such as certain kinds of cancer and heart disease, have increased, giving rise to greater consideration, both in research and in programs, for accommodating this increase.
 
 Certain aspects of sensory and perceptual skills, muscular strength, and certain kinds of memory tend to diminish with age, rendering older people unsuitable for some activities. There is, however, no conclusive evidence that intelligence deteriorates with age, but rather that it is more closely associated with education and standard of living. Sexual activity tends to decrease with age, but if an individual is healthy there is no age limit for its continuance. Many of the myths surrounding the process of aging are being invalidated by increased studies in gerontology, but there still is not sufficient information to provide adequate conclusions. Demographic and socioeconomic influences. In general the social status of an age group is related to its effective influence in its society, which is associated with that group's function in productivity. In agrarian societies the elderly have a status of respectability. Their life experiences and knowledge are regarded as valuable, especially in preliterate societies where knowledge is orally transmitted. The range of activities in these societies allows the elderly to continue to be productive members of their communities.
 
 In industrialized nations the status of the elderly has altered as the socioeconomic conditions have changed, tending to reduce the status of the elderly as a society becomes more technologically  oriented. Since physical disability is less a factor in productive capability in industrialized countries, this reduction in social status is thought to have been generated by several interrelated factors: the numbers of still able-bodied older workers outstripping the number of available employment opportunities, the decline in self-employment which allows a worker to gradually decrease activity with age, and the continual introduction of new technology requiring special training and education. Although in certain fields old age is still considered an asset, particularly in the political arena, older people are increasingly being forced into retirement before their productive years are over, causing problems in their psychological adaptations to old age. Retirement is not regarded unfavourably in all instances, but its economic limitations tend to further remove older people from the realm of influence and raise problems in the extended use of leisure time and housing. As a consequence, financial preparation for retirement has become an increased concern for individuals and society. Familial relationships tend to be the focus of the elderly's attention. However, as the family structure in industrialized countries has changed in the past 100 years from a unit encompassing several generations living in close proximity to self-contained nuclear families of only parents and young children, older people have become isolated from younger people and each other. Studies have shown that as a person ages he or she prefers to remain in the same locale. However, the tendency for young people in industrialized countries to be highly mobile has forced older people to decide whether to move to keep up with their families or to remain in neighbourhoods which also change, altering their familiar patterns of activity. Although most older people do live within an hour from their closest child, industrialized societies are faced
 with formulating programs to accommodate increasing numbers of older people who function independently of their families.
 
 A significant factor in the social aspects of old age concerns the values and education of the generation itself. In industrialized countries especially, where changes occur more rapidly than in agrarian societies, a generation born 65 years ago may find that the dominant mores, expectations, definitions of the quality of life, and roles of older people have changed considerably by the time it reaches old age. Formal education, which usually takes place in the early years and forms collective opinions and mores, tends to enhance the difficulties in adapting to old age. However, resistance to change, which is often associated with the elderly, is being shown to be less an inability to change than a trend in older people to regard life with a tolerant attitude. Apparent passivity may actually be a choice based on experience, which has taught older people to perceive certain aspects of life as unchangeable. Adult education programs are beginning to close the generation gap; however, as each successive generation reaches old age, bringing with it its particular biases and preferences, new problems arise requiring new social accommodations.


\7 sleep problems

The changes that aging brings tend to come upon us unnoticed at first...like the passing of the seasons. Slowly, over time, we become aware that our eyesight is less keen or our hearing less acute. In the same way, our experience of sleep is altered. It's not that our sleep needs decline with age. In fact, research demonstrates: Our sleep needs remain constant throughout adulthood. Most of us still require the same seven to nine hours of sleep a night that we did when we were younger, even in our golden years. 

However, a good night's rest may prove more elusive as we grow older. Lifestyle changes and behavioral practices may play their part. Daytime naps may make us less tired at bedtime. Poor sleep habits may have become entrenched; we may associate our beds with television or reading, not sleeping. Stress and bereavement may lead to early awakenings or interrupted sleep. And in the silence of our bedrooms, the bark of a neighbor's dog or a passing siren may trouble us more than when we were younger. 

Med conds and the physical changes associated with aging may play their own roles. Nighttime aches and pains may lengthen the time it takes to fall asleep...and interrupt sleep thereafter. A number of medical and psychiatric conditions may affect sleep adversely. And there are many med disorders more common among older people. 

For exam, older elderly people suffer from at least four sleep disorders in numbers far greater than younger people: sleep apnea, restless legs syndrome, periodic limb movements disorder, and advanced sleep phase synd- rome. (The good news is that these are all treatable conds.) Med problems that include arthritis, heartburn, osteoporosis, and heart and lung disease may also inter- rupt, delay or abbreviate sleep, as may some of the drugs used to treat these conditions. The need to use the toilet more often may make nighttime risings common. Psychiatric conds including depression and anxiety may lead to sleep difficulties as well. 

SLEEP CHANGES AS WE GROW OLDER - Sleep architecture (or stages) changes with age. Nighttime sleep is more likely to be disturbed. The elderly tend to experience more conditions that adversely affect sleep quality and dura- tion. Older people tend to nap more than younger adults. 

 HOW SLEEP CHANGES - Before examining how sleep changes with age, it's necessary to understand the basic sleep stages. Normal sleep consists of two major states: REM (Rapid Eye Movement) sleep and NREM (nonREM) sleep. NREM sleep is divided further into four sleep stages, numbered stage 1, 2, 3 and 4. Sleep typically begins with stage 1 before progressing into the later stages. Sleep deepens with each stage achieved; stages 3 and 4 (also called delta sleep) provide our bodies' deepest sleep. Our fifth stage is REM sleep, where dreaming occurs. 

WHAT DO SLEEP STAGES HAVE TO DO WITH SLEEPING WELL? In general, changes in one's sleep architecture or stages affect how deep sleep is. Middle-aged and elderly people tend to spend less time in deeper sleep than younger people. By age 60 or 70, many adults experience a decrease in the proportion of time spent in delta sleep. This is particularly true for elderly men. However, the percentage of REM sleep remains relatively stable. 

In late adulthood, the first REM sleep periods come faster than in earlier years. Are the kinds of dreams experienced different? Some research suggests that older men tend to have more passive, inner-directed dreams, while older women tend to dream more active, outgoing dreams. 

ARE YOU SLEEPING MORE, BUT ENJOYING IT LESS? Interest- ingly the average total sleep time increases slightly after age 65. But so do reports of difficulty falling asleep. One study found that after 65, 13% of men and 36% of women reported taking more than 30 min to fall asleep.

What causes this difficulty? Research suggests that physiological and lifestyle changes are at fault. The elderly generally secrete lesser amounts of certain chemicals that regulate the sleep/wake cycle. Both melatonin (a substance produced by the pineal gland that promotes sleep) and growth hormone production decrease with age. There are also changes in the body temperature cycle which occur with age. These factors may cause, or be a consequence of, sleep problems. 

In addition, a decrease in exposure to natural light and a change in diet may exacerbate sleep difficulties. Some researchers theorize that daytime inactivity (lack of exercise) and decreased mental stimulation may also lead to the "aging" of sleep. 

Falling asleep isn't the only difficulty older people may face at night. Sleep also becomes more shallow fragmented and variable in duration with age. The elderly wake more frequently than younger adults. Recent research suggests that the aging bladder can contribute to a substantial degree of sleep disturbance in the elderly. A tendency to feel sleepier during the day than when younger results from these increased nocturnal awakenings. It's important to remember that many healthy elderly individuals have no or few sleep problems. 

PERSISTENT TROUBLE FALLING ASLEEP AT NIGHT OR FREQUENT DROWSING BY DAY IS NOT NORMAL OR INEVITABLE WITH AGE. Sometimes, age-related changes mask underlying sleep disorders. For example, sleep apnea, a breathing disorder, is more common in the middle and elder years. The repeated awakenings caused by a literal lack of breath lead to daytime sleepiness. 

How to tell whether daytime drowsiness is a result of a sleep disorder, sleep deficit or depression? By consult- ing a sleep specialist, who is skilled in diagnosing the problem and treating both symptom and cause. Many older people consider poor sleep not worth complaining about and as inevitable and constant as death and taxes. 

THERE ARE MANY THINGS YOU CAN DO ABOUT POOR SLEEP, AND THERE ARE MANY REASONS TO DO SOMETHING ABOUT SLEEP. 

THE IMPACT OF SLEEP PROBLEMS - Sleep deprivation has measurable negative effects on performance and physical and mental health. If you haven't had a good night's sleep, you're likely to pay for it. The price may be high: Reduced energy, greater difficulty concentrating, diminished mood, and greater risk for accidents, incl fall-asleep crashes. Work performance and relationships can suffer too. And pain may be intensified by the physical and mental consequences of lack of sleep. 

MEDICAL PROBLEMS AFFECTING SLEEP - First, the bad news: Older people are likely to suffer both medical disorders that may disrupt sleep and specific sleep disorders. The medical disorders include: Arthritis, Osteoporosis Heartburn, Cancer, Parkinson's Disease, Dementia Alzheimer's Disease, Incontinence, Congestive Heart Failure, Gastroesophageal Reflux (GER), Nocturnal Cardiac Ischemia, Chronic Obstructive Pulmonary Disease, Peripheral Vascular Disease.
 All these med prob can interrupt, delay and/or shorten sleep. 

For example, arthritis patients may have difficulty falling asleep because of painful joints. Or they may be awakened by pain. A 1996 National Sleep Foundation (NSF) Gallup Poll found that 30 percent of all nighttime pain sufferers experience arthritis pain at night. The number rises to 60 percent for those over age 50. Nighttime pain sufferers in this age group who experience difficulty sleeping lost an average of 2.2 hours of sleep, 10.7 nights a month. If you suffer from arthritis, ask your doctor about treatment. 

Other types of chronic or occasional pain can be sleep- stealers too. In the 1996 NSF Gallup Poll, back pain was cited by 64% of those who had nighttime pain in the past year. Headaches, muscular aches and pains, leg cramps and sinus pain were cited by 44% to 56%. Behavioral and pharmacological approaches may help. 

Heart patients often suffer sleep difficulties as well. Most stable congestive heart failure patients suffer sleep-disordered breathing. Almost half in a recent study had apneic (loss of breath) attacks. (More on apnea later.) Apnea requires treatment as well. 

When GER whose chief symptoms are heartburn and regurgi- tation occurs during sleep, nocturnal awakenings may follow. About five percent of Americans suffer from heartburn nearly every day. Daytime GER is normal after eating. Nighttime GER can be problematical and marked by wheezing and chronic cough. Repeated awakenings and daytime sleepiness may ensue. Raising the head of the bed may alleviate symptoms. Or drugs may be indicated. 

Other med conds affect sleep too: asthma, chronic interstitial lung disease, neuromuscular disease, etc. Individuals with asthma may experience frequent awakenings due to bronchospasm. One study found such awakenings weekly in 74% of asthmatic patients. 

HOT FLASHES - Menopause is another source of potential sleep problems...for women. The hot flashes and assoc breathing changes that most women experience during this time appear to disturb sleep and may lead to daytime fatigue. 75% of menopausal women suffer from hot flashes, on average for five years. While the total sleep time for women suffering hot flashes did not differ from women who didn't experience them in one study, hot flashes were assoc with more frequent arousals: once every eight mins on average. Next-day fatigue and lethargy seem to be more likely consequences than excessive daytime sleepiness. 

Apnea rises in women starting at age 50. Women who experience apneas and hot flashes appear likely to experience the latter before the former. This respiratory connection was explored in research using "paced respira- tion," or scheduled breathing at the beginning of the hot flash. This approach significantly reduced the frequency of hot flashes. 

Another approach involves hormonal treatment with proges- terone and estrogen. (Hot flashes are assoc with reduced estrogen production.) Naps may help alleviate fatigue too. However, if insomnia is a prob, naps shd be avoided. They can contribute to nighttime sleep difficulty. 

INSOMNIA IS A SYMPTOM, NOT A DISORDER IN ITSELF. If you experience difficulty falling asleep, staying asleep, or enjoying a restful night's slumber, you're suffering from insomnia. It's a common symptom in the U.S., reported by nearly half of Americans surveyed in a 1995 National Sleep Foundation (Sleep in America) Gallup Poll. Insomnia may last for days (transient), weeks (short-term) or months (chronic). 

Some think that the longer insomnia lasts, the harder it becomes to treat. If you suffer from insomnia that lasts for more than a few days, you should consult your doc. The underlying cause should be identified, if possible, then treated. Unfortunately, this is not always possible. Chronic insomnia will probably need longer term treatment than other types. Sleep med is usually considered a short-term solution. 

INSOMNIA MAY BE CAUSED BY MANY FACTORS: Stress, Depression, Anxiety, Physical illness including Restless Legs Syndrome (RLS), Caffeine intake, Irregular schedules, Circadian rhythm disorders, Drugs (incl alcohol and nicotine), Occasional or chronic pain. 

If the cause of insomnia is... Treatment may include... Stress, Depression, Anxiety Psychotherapy and/or med. Excessive alcohol intake or abuse. Psychotherapy and/or med. Irregular sleep schedule. A regular sleep/wake schedule. Exercising too close to bedtime. Exercising earlier in the day. Caffeine too close to bedtime. Eliminating late afternoon or evening caffeine. Nicotine Smoking cessation Assoc bed with alert activities. Establishing relaxing bedtime schedules. 

Insomnia may be secondary to other disorders as well, such as restless legs syndrome or advanced sleep phase disorder. These sleep disorders are more common in the elderly too. Moreover, they increase in frequency as we enter middle age. Other sleep disorders more common in the elderly are characterized by noise and movement. 

NOISY SLEEPERS - Out of the mouth of babes snores are rarely heard. Snoring increases with age. It's caused by the partial obstruction of the airway during sleep. About 40% of the adult pop snores. Snoring is more common among those who are middle-aged or older and overweight. 

THE SLEEP APNEA CYCLE - During the night... Breathing stops. Blood oxygen levels drop. Individual wakes briefly, gasps for breath. Repeat. Next day... Sleeplessness is excessive 

SNORING MAY BE ASSOCIATED WITH DAYTIME SLEEPINESS. Loud snoring punctuated by multiple, nightly brief episodes of breathing cessation suggest the presence of sleep apnea. Sleep apnea, like snoring, is more common among the obese. However, in elderly people, the obesity-sleep apnea connection is far less pronounced. Sleep apnea occurs in four percent of middle-aged men and two percent of middle-aged women. In males over 65, the figure rises to 28%; for women, the number climbs to 24% 

Sleep apnea is treatable. Unfortunately, the vast majority of sufferers don't know they have the disorder. It is often a bed partner's concern that triggers diagnosis and treatment. Sadly, sleep apnea is linked to a three to seven time increase in risk for falling asleep at the wheel. Diagnosis and treatment are important. 

What does diagnosis entail? For an objective evaluation, individuals should seek referral to a sleep disorders clinic. In an overnight sleep study at a sleep disorders clinic, individuals are monitored by noninvasive polysomnographic equipment that measures respiration (breathing) and arousal through EEG (brain wave) readings. If the disorder is mild, a sleep specialist may recommend weight loss, use of pillows and/or change in sleep position (avoiding lying on one's back), and abstinence regarding alcohol and sedatives which worsen apnea. However, if the disordered breathing is moderate to severe, a device known as a CPAP (continuous positive airway pressure) is in order. This device gently propels air into the airway, keeping it open. Treatment with dental devices and surgery are other alternatives to be considered. 

ON THE MOVE - A discussion of movement disorders affecting sleep brings us to PLMD (note the L) and RLS. The L stands for legs, the limbs most affected in these disorders. In PLMD (periodic limb movements disorder), periodic leg movements disrupt the sufferer's night: Legs jerk repeatedly, kicking every 20 to 40 seconds through the night. Not surprisingly, these leg kicks trigger frequent arousals. The end result? Daytime sleepiness and nighttime insomnia.
 While PLMD may be diagnosed infrequently by primary care physicians, the disorder is all too common among the elderly. In one study, approximately 45 percent of the elderly had at least a mild form of PLMD. As with sleep apnea, evaluation at a sleep disorders center is the first step. 

Drug treatment can be very successful, with anti-Parkinsonian drugs (e.g., carbidopa-levodopa) controlling the majority of cases. Other medications include dopamine agonists and sedative-hypnotics (calming, sleep-inducing medications). Patients should be monitored closely during treatment for side effects or adverse reactions. Achieving the proper dose of the most effective medication may take time. 

ARE YOU A NIGHTWALKER? RLS, or restless legs syndrome, is less common than PLMD. The distinction between the two disorders is that in RLS, the leg movements occur continually when the body is at rest. The movements of PLMD occur in sleep. 

RLS symptoms include an uncomfortable sensation in the foot, calf or upper leg that feels like something is crawling or moving inside the limbs, or tickling or aching deep inside them. This sensation is yoked with a compulsion to move the legs. Movement resolves the symptoms, but the syndrome is unrelenting. Within seconds or minutes, the sensations return. If the legs are not moved, they frequently jump involuntarily. Since rest brings on symptoms, and walking offers relief, sufferers are often called nightwalkers. 

Symptoms are always worse at night and sometimes only present nocturnally. If individuals do manage to fall asleep, leg movements lead to frequent awakenings or near awakenings. Next-day fatigue is endemic. 

Although the precise cause of RLS remains a mystery, in some cases, RLS may be due to iron deficiency, dialysis, pregnancy or peripheral neuropathy. Iron deficiency is a common and eminently treatable cause. Pregnancy, of course, is time-limited. In some cases, polysomnographic evaluation may not be indicated. However, there are other cases, particularly if there is accompanying neurologic disease, or if the movements have an aggressive or generalized quality to them, that may require a polysomnographic evaluation. Treatment can begin immediately with the same range of medications as indicated for PLMD. 

DO YOU ACT OUT YOUR DREAMS? One sleep disorder combines dreams with movement: REM sleep behavior disorder. Most sleepers are virtually paralyzed during REM or dreaming sleep; people with REM sleep behavior disorder do not have this motor inhibition and literally act out their dreams. They may crash into furniture, break windows or fall down stairs, leading to self-injury or hurting others. Such sleep is hardly restful! Most sufferers are men over 50. Drug treatment with clonazepam can eliminate the dream disturbances and improve sleep for sufferers and those who live with them. 

IS YOUR TIME OF DAY THE NIGHT TIME? NIGHT OWLS & MORNING LARKS - Those suffering from advanced sleep phase syndrome (ASPS) and delayed sleep phase syndrome (DSPS) sleep and wake at inconvenient times. Individuals with ASPS sleep earlier than their desired clock time, while DSPS sufferers find sleep elusive for hours after their desired clock time. Trying to sleep when their bodies are alert, or rise when their bodies are sleepiest, can lead to insomnia or excessive daytime sleepiness. Individuals may rely on sleeping pills or alcohol to manipulate their sleep schedules. DSPS patients may appear to be suffering from insomnia, especially if they insist on trying to sleep at a "normal" bedtime. One distinguishing characteristic is that in other types of insomnia, sleep problems include that of maintaining sleep throughout the night. DSPS sufferers have no problem sleeping...if they observe their own schedules. Another distinction is that most chronic insomniacs experience a variability in their nighttime experiences. This is not the case for DSPS patients. Treatment of DSPS requires "resetting" the biological clock by using bright light exposure, medication or chronotherapy. Chronotherapy involves delaying bedtime by three hours progressively each day until the desired bedtime is reached. 

Although difficult to accomplish, this approach can work if individuals can alter their schedules daily and protect their sleep from interruptions. Exposure to bright light early in the morning (six to nine a.m.) induces a phase advance, leading to an earlier sleep onset that evening. However, patients must avoid bright light exposure during the evening as this would tend to delay sleep onset. Medication is another option: Hypnotics and melatonin may help, but many questions remain about their duration of use and the long-term safety of melatonin. 

ASPS may be confused with depression. While ASPS appears to be a rare condition, it is more common in seniors. Complaints of difficulty staying awake in evening social situations are one marker of ASPS. Insomnia at the end of the sleep period is another. 

Treatment for ASPS includes bright light therapy and chronotherapy. The three-hour phase advancement of chronotherapy is implemented every other day. The bright light exposure is sched for late afternoon or evening. 

DEMENTIA-RELATED SLEEP PROBLEMS - Alzheimer's disease and senile dementia are characterized by frequent sleep disturbance, both for those so diagnosed and their care- givers. In fact, many caregivers cite sleep disturbances, incl night wandering and confusion, as the reason for institutionalizing the elderly. Once institutionalized, these elderly residents' sleep disturbances don't cease. 

Two-thirds of those in long-term care facilities suffer from sleeping problems. While tranquilizing drugs may be the drugs of choice at many institutions, these drugs can further confusion and increase the risk of falls. Monoaminergic drug therapies, such as modafinil, are under investigation and may improve behavior along with sleep disturbances in these patients. Other categories of medication - including neuroleptics, benzodiazepines, antidepressants, anticonvulsants, and beta blockers - have shown positive effects in some cases. 

Sleep problems should be evaluated in all patients. Depression may be mistaken for dementia, as may the effects of certain medications, malnutrition and alcohol abuse. Many elderly patients suffer from undiagnosed apnea, drug interactions and excessive drug use or dependence. In fact, the elderly use both prescription and over-the-counter medications far in excess of their proportion of the population. Alcohol interacts with many of these drugs. It also may exacerbate dementias not caused by alcohol abuse. 

Some experts advise elderly people to have no more than one alcoholic drink per day, even if they are taking no drugs and have no medical contraindications. That drink should not be taken before bedtime. 

THE WORD ON DRUGS - To make matters worse, older people are more likely to take a number of medications that may adversely affect sleep. Common medications, such as antidepressants (prescribed for depression) and antihypertensives (prescribed to control high blood pressure), may have a negative impact on sleep. Caffeine taken too late in the day (in coffee, tea, soda, chocolate) may lengthen sleep latency, the amount of time it takes one to fall asleep. Alcohol may speed sleep onset but leads to disrupted sleep later in the night. 

Nicotine, too, has been linked to sleep problems. In one study, smokers were much more likely than nonsmokers to report problems falling, and staying, asleep along with daytime sleepiness. Another study found that smokers are four times as likely as nonsmokers to suffer from sleep apnea. Nicotine withdrawal, too, can lead to short-term sleep problems - namely, increased awakenings ? along with a shorter period to fall asleep. Increased daytime sleepiness may follow. 

Use of a skin nicotine patch may also be associated with early morning awakenings and reduced total REM sleep, still another study suggests. Once the patch was removed, the length of time before REM sleep - and the percentage of REM sleep - were reduced. 

SLEEP & TRAVEL - If freedom to travel is one of the silver linings in the "cloud" of old age, jet lag may well be akin to the rain that must fall. For jet lag is the price we pay for crossing time zones. And with age, we appear to pay a heftier price. One study found sleep disruption and daytime sleepiness to be longer lived in the elderly than in younger subjects. Jet lag resolves with time, but short-term use of sleep-promoting medications, sleeping at local time and rising at local time, morning light when traveling west, and avoiding morning light when traveling east, can help reset the biological clock. Melatonin is also being studied in this context. 

TIPS FOR SAFE DRIVING - Get a good night sleep before hitting the road. Plan to drive during the times you're normally awake. Take a mid afternoon break and sleep between midnight and six A.M. Try to drive with a companion, talk to each other, and share the driving. Schedule a break every two hours or every 100 miles. Be on the lookout for early warning signs of drowsiness: Difficulty focusing, Keeping your head up, Stopping yawning, Thinking clearly, Remembering the last few miles, and Staying in your lane. 

BEFORE YOU HIT THE ROAD - It's important to remember that falling asleep at the wheel is a very real and deadly consequence of driving when fatigued. If you're tired, don't drive. 

WHAT'S AHEAD? The good news? Sleep knowledge is growing in leaps and bounds, and sleep research is expanding. Research into the use of melatonin and growth hormone continue; these approaches may prove promising for older adults with sleep problems. At publication time, however, these hormones remain experimental and caution is in order. However, new medications for many sleep disorders are under study, with some nearing U.S. FDA approval. 

THE IMPORTANT THING TO REMEMBER IS THAT: Pursuit of a good night's sleep is a worthy goal...and within reach for many who once thought it impossible


\8 12-Step Program for a Healthier Lifestyle Low-Fat Food Made Fun!

For lower cholesterol, higher energy levels, and weight loss, try incorporating one new healthy habit into your life each month for the next year. Small, gradual changes in lifestyle and diet can pay big health dividends.

WALK, MAN. Since exercise doesn't have to be intense to be beneficial, brisk walking is an ideal choice for those beginning an exercise program. It's inexpensive, it's easy on the joints, it's enjoyable and it works! Ask a friend to join you for a "walkie-talkie" session. 

LAUGH MORE OFTEN. Did you know that 100 hearty, good laughs burn the same amount of calories as ten minutes of rowing? Looks like more giggling leads to less jiggling! 

LEARN LABEL LINGO. A healthy eating plan begins at the grocery store. Food labels contain all the information we need to make smarter choices. 

FOLLOW THE "80/20" RULE. Eighter percent of the time, choose foods that are nutritious, low in fat, and high in fiber. Twenty percent of the time, allow yourself to have an indulgence. This way, you'll never feel deprived, and no foods will be "off limits" or "taboo." 

THINK "FITNESS," NOT "THINNESS." Throw unrealistic notions of becoming pencil thin or perfectly chiseled out the window. Anyone, of any body type, of any age, of any height, can become "fit" through regular exercise and a healthy diet. 

REMEMBER: YOU BOOZE, YOU LOSE. Cut back on your alcohol consumption. If you drink regularly, say, two beers or two glasses of wine each day, that's over 1400 calories per week, or over 73,000 calories per year - enough to create 20 pounds of excess flab! 

KICK THE HABIT. Try replacing butter, mayonnaise and fat-laden dressings with new low-fat ones, like honey- mustard on your sandwiches and jam on toast. 

DON'T BE A FREQUENT FRYER. Choose cooking methods that don't add fat to your foods: baking, broiling, grilling, roasting, poaching and steaming. 

GIVE YOUR SPUDS SOME NEW DUDS. Instead of butter when mashing potatoes, try using low-fat sour cream or butter- milk to get the creamy taste and texture. Try salsa on baked pototoes - it's fat free! 

PLAN MENUS IN ADVANCE. When you know what you're going to eat ahead of time, you avoid impulsive high-fat, high- calorie food selections. 

KILL TWO BIRDS WITH ONE STONE. Doing two things at once may be just the way to fit exercise into a hectic schedule. Catch up on the latest gossip with your best friend while hiking, biking or golfing. 

PREPARE YOURSELF FOR A SNACK ATTACK. Keep health snacks on hand like fresh fruit, pretzels, skim milk puddings, baked tortilla chips, low-fat cereal bars, veggies with low-fat dip, low-fat muffins, and frozen yogurt. 

FOOD FACTS - (Courtesy of Wisconsin State Cranberry Growers Assoc.)

The cranberry gets its name from Dutch and German settlers, who called it "crane berry." When the vines bloom in late spring and the flowers' light pink petals twist back, they have a resemblance to the head and bill of a crane. Over time, the name was shortened to cranberry. 

The cranberry is one of only three major fruits native to North America, the other two being the blueberry and the concord grape. 

During the days of wooden ships, American vessels carried cranberries. It was the cranberry's generous supply of  vitamin C that prevented scurvy. 

The hearty cranberry vine thrives in conditions that would not support most other crops: acid soil, few nutrients and low temperatures, even in summer. 

QUICK RECIPE TIPS - Steam green, leafy vegetables, such as spinach or broccoli, in seasoned broth. Beat eggs with seasoned broth instead of water or milk for fluffy, flavorful omelets. For flavorful, low-fat rice or pasta, substitute broth for water when cooking, omitting the butter and salt. Use beef broth to simmer pot roasts, Swiss steak, ground meat for tacos or Sloppy Joes. 

UNIQUE FOOD PRODUCTS - Green tea, recognized for centuries by Eastern cultures for its curative powers, delicate taste, and myriad health- and home-applications, green tea is finally gaining notice in the Western mainstream. Recent studies have found green tea may help fight viral infections, inhibit the effects of aging, and reduce the risk of cancer and heart disease. Multipurpose tea can be used in topical beauty applications to promote youthful skin, healthy feet and fresh breath! 

Broccolini, a cross between broccoli and Chinese kale, is completely edible, from its loose, tender flower to its willowy stem. Its sweet, delicate crunchiness, peppery bite, and elegant, long stalks nominate it for a star role in an unlimited range of dishes from Mediterranean to Asian and regional American recipes. 

FOOD TRENDS (Courtesy of Hilton Hotels) - More people are eating desserts! Requests for "sinful" sweets have increased over the past five years, and there are fewer people willing to share them. (Hilton Hawaiian Village) 

This property has witnessed the exploding interest in Pacific Rim cuisine and has taken great strides to include native ingredients in dishes. (Hilton Waikoloa Village) Instead of using cream or butter in cooking, the resort's signature restaurant, Different Point of View, features dishes that incorporate unique salsas, vegetable sauces and fresh herbs to create their signature flavor. (Pointe Hilton Tapatio Cliffs Resort) 

Fulfilling guest requests for fresh creations and more buffet-style meals, and then marrying it with the trend toward lower fat consumption, this property created the popular build your own seafood platter. The best of both worlds. (Hilton Virginia Beach Oceanfront) 

During the past five years, guest concern about fat content has increased, yet more people than ever are ordering red meat while the number of requests for smaller portions is declining. First made popular on the West Coast, Fusion Foods are now appearing in restaurants throughout the country. This cooking style was pioneered by chefs at this San Diego resort. (Hilton San Diego Mission Bay Resort) 

This resort fields more guest requests for Florida's fresh fish and fruits. As a result, their menu items now incorporate mroe local ingredients, such as Red Snapper in a fresh citrus salad and pan-roasted Florida Pompano in barbecue mango baste. India is the world's largest producer of mangoes, but the largest domestic crop of this delectable fruit is found in Florida. (Fontainebleau Hilton Resort and Towers) 

More guests than ever are enjoying premium coffee with their sweet desserts. Consumption of fancy java blends such as cafe mocha and cappuccino continues to rise. (Hilton Palm Springs Resort) 

Who do you think is boss when it comes to family vacations? Kids big and small, of course! Proof of this: the most popular mini-bar item at this resort is Rice Krispie Treats. (Hilton San Diego Mission Bay Resort) 

HISTORY & FOOD - Legend holds that caramels were first created when a Chicago butterscotch maker in 1875, added small amounts of milk to improve the texture of his candy. 

Caramel means "burnt sugar" and has its roots in the Latin word for cane sugar. The browning reaction between the milk, sugars and proteins develops the characteristic "carmelization." Amazingly, more than 100 different styles of caramels can result from the same ingredients, depending on the temperature and speed at which they are cooked. 

Dan Walker, a sales rep for Kraft Foods during the 1950's is credited with "inventing" the caramel apple. As his son Clyde tells it, his parents purchased a candied apple for him - an apple coated with a hardened red sugar coating. All of a sudden, his parents looked at each other and said almost at the same time, "What about caramels?!" After much experimentation in the kitchen, they discovered the right recipe - "the one that kept the caramel stuck to the apple, but still left it creamy enough to bite into." 

In 1964, the year of tie-dye, the Brady Bunch, bell- bottoms, and the Rubic's Cube, Kellogg's revolutionized the breakfast industry with the introduction of Pop-Tarts toaster pastries. On the eve of their 35th. anniversary in 1999, Pop-Tarts are available in more than 14 flavors and are available in nine countries.


\9 Optimism could be key to prolonging life, study finds

Keeping a positive attitude about aging can extend life by seven and half years, which is longer than gains made by not smoking and exercising regularly, a study finds.

"People's perception of aging predicted the length of their survival," said Dr. Suzanne Kunkel, director of the Scripps Gerontology Center at Miami University and co-author of the study.

"It illustrates the mind-body connection. Even if we cannot control what happens to us, we can control how we define it."

The findings about attitude and survival rates were made by analyzing and matching data collected since 1975 about 660 people age 50 or older in Oxford, Ohio, with data from the National Death Index.

Kunkel began the research in the small southwestern Ohio town as a graduate student and has helped maintain the database for more than two decades.

Researchers at Miami and Yale universities looked at how the 338 men and 322 women responded to several questions about aging in 1975, and then examined how their responses predicted their survival up to 23 years later.

The study, published in the Journal of Personality and Social Psychology, was funded by the National Institute on Aging.

Researchers found respondents with more positive views on aging live longer, even after taking into account factors such as age, gender, socio-economic status, functional health, self-reported health and loneliness.

"The median survival of those in the more positive self perceptions of aging group was seven and a half years longer than those in the more negative perceptions," Kunkel said.

The attitudes on aging had a greater impact on life span than lower body mass index, not smoking and regular exercise - each of which extends life by one to three years.

"Our study carries two messages," said Dr. Becca Levy, a researcher at Yale University and the study's lead author. "The discouraging one is that negative self perceptions can diminish life expectancy; the encouraging one is that positive self-perceptions can prolong life expectancy."

But Richard Suzman, associate director for behavioral and social research for the National Institute on Aging, said while a positive self perception helps, it should not replace proper health care.

"Any notion that positive thinking is more powerful than not smoking ... there just isn't evidence of that," he said. "There is enormous clinical evidence to show the value of not smoking and exercising."

The researchers found that the will to live partially accounts for the relationship between positive self perceptions of aging and survival, but does not completely account for difference in longevity.

Levy's earlier research at Yale's Department of Epidemiology and Public Health has shown cardiovascular response to stress can be adversely affected when elderly persons are exposed to negative stereotypes of aging.

The new study said stereotypes about aging are acquired decades before the person becomes old and are therefore rarely questioned.

"Once individuals become older, they may lack the defenses of other groups to ward off the impact of negative stereotypes on self perceptions," the report said.

Kunkel said the study offers a strong message about life.

"There is nothing we can do about aging," she said. "It's like sitting in traffic when you're late. The natural response is to get very stressed about the situation. The other choice is to not get upset and think about how to deal with the consequences of being late."

The key is learning how to see a situation for what it is, she said, and to give it no more power than it needs to have.

"We enter later adulthood with our habitual ways of dealing with stress," she added. "People need to learn new strategies to deal with it."
