Older -- But Coming on Strong

By Anastasia Toufexis

Doctors who specialize in treating old people delight in telling the story of a 90-year-old man named Morris who has a complaint about his left knee. Says his exasperated physician: "For heaven's sake, at your age what do you expect?" Rejoins Morris feistily: "Now look here, Doc, my right knee is also 90, and it doesn't hurt." It is an apocryphal tale with a pointed message. As long as anyone can remember, old age and disability have been paired as naturally and inevitably as the horse and carriage or death and taxes. After all, advancing years have been seen by most people as an inexorable slide into illness, impotence and immobility.

No longer. Nowadays America's seniors are giving the lie to that grim vision. Fully half of all people now 75 to 84 are free of health problems that require special care or that curb their activities, according to surveys. Says Sociologist Bernice Neugarten of Northwestern University: "Even in the very oldest group, those above 85, more than one-third report no limitation due to health." Declares Dr. Richard Besdine, director of the aging center at the University of Connecticut: "Aging doesn't necessarily mean a life that is sick, senile, sexless, spent or sessile."

That more cheerful view of growing old is gaining currency mainly because of the rapidly expanding scientific discipline of gerontology. Modern studies of the aging process involve everyone from laboratory researchers examining brain tissue to nutritionists interviewing nonagenarians to physicians specializing | in treating the elderly. The goal of gerontology is not to extend the upper limit of human life -- now about 115 to 120 years of age -- but to make the lives of the elderly less burdensome physically and more rewarding emotionally. "The new focus," says Dr. John Rowe, director of the division on aging at Harvard Medical School, "is not on life-span but on health- span."

Although still in its infancy, gerontology has produced major revisions in doctors' understanding of how people grow old. Explains Dr. T. Franklin Williams, director of the National Institute on Aging: "It's the diseases that we acquire in later years that really cause the deterioration of functions." Or, as Dr. Robert Butler of Mount Sinai School of Medicine in New York City puts it, "Disease, not age, is the villain." The good news is that in many instances, physical disorders that afflict the aging can be effectively treated. Today even multiple afflictions do not necessarily incapacitate a person. Citing the case of a man of 75 who has diabetes, heart disease and a history of cancer, Rowe points out, "You can't tell me whether that man is in a nursing home or sitting on the Supreme Court."

How long and how well one lives, of course, depend in part on heredity. The chances of blowing out 85 candles go up 5% with each parent or grandparent who has passed that milestone. A family history of certain ailments, such as breast or colon cancer, heart disease, depression or alcoholism, extends the risk of developing such problems. Increasingly, though, researchers believe personal habits and environmental influences may hold the key to why some people are more "successful" at aging than are others. "You find a tremendous variability between individuals," observes Rowe. "The older people become, the less alike they become."

Many of the fears people have about aging are greatly exaggerated. Senility is probably the most dreaded of all debilities, yet only about 15% of those over 65 suffer serious mental impairment. Alzheimer's disease, now considered the scourge of old age, accounts for more than half that total. For much of the remainder, mental impairment from conditions such as heart disease, liver or thyroid trouble and dietary deficiency is either reversible or preventable.

Another frequently overlooked culprit: overmedication. Nearly 80% of people 65 and older have at least one chronic condition (top four: arthritis, high blood pressure, hearing impairment, heart disease); about one-third have three or more. To combat their problems, they rely on a battery of over-the-counter and prescription drugs. The majority of people in this age group use more than five medications, and 10% take more than twelve. Interactions among drugs, as well as too much of some drugs, can cause a host of complications, from mental confusion to slowed blood clotting to disturbance of the heart's rhythm.

Depression, often mistaken for senility, or dementia, is by far the single most ignored disorder among the elderly. About 15% of older people suffer from the condition, double the figure for the general population; the elderly have the highest suicide rate of any age group. Drugs account for some of the high incidence of depression. But the old are also more vulnerable because they have suffered more major stresses, including the deaths of spouses or friends, living alone, retirement from a job, serious illness. The classic symptoms of depression -- guilt, hopelessness, sleeplessness, lack of appetite, and suicidal thoughts -- are more likely to be noticed in younger people because they are so out of character. But families and doctors too often overlook depression in the elderly. The warning signs may sometimes be subtle: headaches, stomach ailments, vague complaints of not feeling right. And there is always the tendency to dismiss the signals as normal aging, just old folks' crankiness. When depression is recognized, counseling and drugs successfully treat three-quarters of the cases.

Flagging libido and sexual ability have also been wrongly equated with advancing years. Women supposedly lose interest in sex after menopause; in fact, desire normally remains strong throughout life. The dampening of sexual urges often results from physical problems, such as hot flashes and vaginal dryness, which may be alleviated by estrogen therapy, lubricants and attention to nutrition and exercise. Older men, for their part, routinely accept continued impotence as normal. It is not. As a man ages, he does need more time to achieve an erection. But almost all impotence, whether psychological or physical, is reversible. Among the common physical causes: diabetes, heart disease and chronic alcohol abuse.

Yet another widely held fear is that wear and tear on the joints inevitably leads to painful and immobilizing arthritis. Yes, there is a wearing down of the cartilage pads that cushion bones, but less than half of those over 65 whose X rays show degenerative arthritic changes suffer symptoms. Many of the aches and pains attributed to acute arthritis, doctors say, have more to do with weakening muscles than creaky joints. People with some joint damage fare better when they engage in regular moderate exercise, such as walking or swimming.

Aging, however, is hardly a benign process. Acknowledges Dr. Christine Cassel of the University of Chicago: "By and large, the changes are decremental. Every organ is losing reserve capacity." That means a decline in the ability to recover from physical stresses. A 60-year-old and a 20-year-old who race around the block may start out with the same pulse rate, notes Vincent Cristofalo, director of the University of Pennsylvania's center for the study of aging. "Even when they stop," he notes, "their pulses may be only a little different. The big difference will be in how long it takes for each person's pulse rate to return to normal."

Slowed recovery has a profound impact when it comes to illness. With advancing years, bones take longer to knit, wounds to heal and infections to clear up. Ultimately, says Cassel, the difference is that a "healthy young person can lose a lung, a kidney and do fine. And so too an old person can be doing fine, but then he has a stroke, a heart attack, whatever. Because of the stress, it's much more likely that all the major organs will go one after the other."

There are some striking physiological changes that accompany age. Among them:

-- The immune system starts to decline at around age 30. For instance, white blood cells that fight off invaders, such as viruses and bacteria, lose their effectiveness as a person gets older. The gradual weakening of the immune system makes it harder to stave off illness.

-- Metabolism begins to slow at around age 25. For each decade thereafter, the number of calories required to maintain one's weight drops by at least 2%. Muscle mass gradually shrinks. As a result, people tend to get fatter. Kidneys may lose up to 50% of their efficiency between ages 30 and 80. Some of the liver's functions may decline. Thus alcohol remains in the body longer. So do drugs, a fact doctors are beginning to consider in deciding on dosages for older patients.

-- Lungs lose on the average 30% to 50% of their maximum breathing capacity between ages 30 and 80. Blood vessels lose elasticity, though the heart stays astonishingly well preserved. Notes Cardiologist Jerome Fleg of the National Institute on Aging: "The heart of a normal 80-year-old can pump blood as effectively under stress as that of a normal 30-year-old."

-- Bone mass reaches its peak in the 30s for both men and women, then begins to drop by about 1% a year. In women the rate surges for a few years after menopause. About 24 million Americans, the vast majority of them women, develop osteoporosis, a condition in which the bones become dangerously thin and fragile. Brittle bones are the major cause of the fractures, particularly of the hip, that cripple many of the elderly. Alcohol and tobacco use accelerates bone thinning. Another reason to stop smoking: women who use tobacco reach menopause about two years earlier than women who do not.

-- The senses flag. Taste diminishes as the nose loses its sense of smell (odor accounts for about 80% of overall flavor sensation). The loss of taste can lead to lack of appetite and sometimes to serious nutritional deficiencies. Hearing fades, particularly in the high-frequency range, and processing of information slows. Vision begins deteriorating at about 40. The pupil shrinks, reducing the amount of light reaching the retina. An 80-year- old's retina receives only about a sixth of the light that a 20-year-old's does. The lens hardens and clouds. More than half of those 60 and older have some cataract formation.

-- Changes occur in the skin. The topmost layer, or epidermis, becomes dry and blemished. The middle layer, or dermis, thins dramatically, making the skin seem translucent, and becomes much less elastic and supportive. These changes, along with loss of fat from the underlying subcutaneous layer, cause the skin to sag and wrinkle. Drinking, smoking and suntanning speed up these processes. With less fat and a decline in the activity of sweat glands, the skin becomes a less efficient regulator of body temperature. The result: older people have a harder time staying warm and cooling off. Protective pigment-forming cells that absorb the sun's harmful rays are reduced by 10% to 20% for each decade of life, thus increasing susceptibility to skin cancers.

-- The need for sleep gradually diminishes. Newborns sleep 16 to 18 hours a day; by age 65, three to six hours a night, perhaps with a nap during the day, is typically all that is necessary. The quality of sleep changes, becoming lighter and more fitful. Shorter, restless nights lead many who recall the easy slumber of youth to complain of insomnia. As a result, half of elderly women and one-quarter of elderly men take largely unneeded sleeping pills.

-- The brain loses an average of about 20% of its weight, but as Neurologist David Drachman of the University of Massachusetts points out, "there is redundancy in the brain. It's like the lights in Times Square. Suppose you turn off 20% of the bulbs: you'll still get the message." Speed of recall and mental performance slow, but essential skills remain intact. Researchers speculate that memory loss among the elderly may be something of a self- fulfilling prophecy. Old people are supposed to have memory problems, so they may be more aware of, and bothered by, occasional lapses than are younger people.

So far, gerontologists have no surefire prescription for staying healthy longer, but they do make some strong recommendations: stay out of the sun, cut back on drinking and stop smoking. They stress that it is never too late to adopt better habits. A person of 70 who stops smoking immediately reduces the risk of developing heart disease. The elderly should follow general principles of a sound diet: avoid foods rich in cholesterol or saturated fat, such as eggs and beef, and eat more chicken and fish. Seniors should stress high-fiber foods, including whole-grain cereals and many fruits, and items rich in vitamins A and C, such as broccoli and cantaloupe.

Though some vitamin or mineral supplements may be beneficial, experts warn that taking excessive doses of nutrients is dangerous. Moreover, the combination of too much of a supplement and certain medications can cause trouble. For example, excessive vitamin E by itself can lead to diarrhea and skin rashes. Taken with certain blood-thinning drugs, large doses of vitamin E can trigger severe internal bleeding.

Exercise, at least half an hour three times a week, is an important aid to controlling weight, keeping bones strong, building muscle strength, conditioning the heart and lungs and relieving stress. Declares Physiologist William Evans of the U.S. Department of Agriculture-Tufts University center on aging: "There is no group in our population that can benefit more from exercise than senior citizens. For a young person, exercise can increase physical function by perhaps 10%. But in an old person you can increase it by 50%." The advice is catching on: a Gallup poll taken at the end of last year found that 47% of those 65 and older regularly engage in some form of exercise.

Such seniors are living proof that aging is not synonymous with illness, that increasing years do not necessarily lessen desires or capabilities. That is a welcome surprise, particularly to the old. Muses Margaret Strothers Thomas, 72, a retired teacher from Philadelphia: "As a child I used to look at older people, and they were bent over, stooped and complaining. I can't believe that when you reach the age that you've feared you feel great." Achieving better health for longer requires a continual alertness to false assumptions about old age, whether they come from family, friends, doctors or the old. Declares Thomas: "I have lived so many years, but I'm not old. I have a very positive outlook on life."

More of such moxie is in order. Resignation exacts as heavy a toll on the road to old age as disease or poor habits, warn gerontologists, who stress the importance of cultivating new interests and staying mentally engaged. That view is shared by no less an authority than Comedian George Burns. "People practice to get old," he avers. "The minute they get to be 65 or 70, they sit down slow, they get into a car with trouble. They start taking small steps." Burns stays young by taking fearless strides. He plans to play the London Palladium on his 100th birthday -- eight years from now.

With reporting by J. Madeleine Nash/Chicago and Dick Thompson/Washington