Gerontologists have known for many years that restricting the
energy intake of rats prolongs their lifespan by as much as 30%. A
study in monkeys (Journal of Clinical Endocrinology and
Metabolism 1997;82:2093-6) has now shown that substantially
restricting their energy intake resulted in a slowing of the normal age
related decline in the steroid hormone dehydroepiandrosterone sulphate.
This hormone is an established marker of aging - though the researchers
have been careful to warn that adding it to the human diet has not been
shown to give any benefit.
Minerva has read with interest, over many years, accounts of the
Ranch Bernardo study in California. The subjects are a couple of
thousand men and women aged 50-93 living in an affluent retirement
community (Circulation 1997;96:37-43). Follow up has
shown that serum concentrations of total and low density lipoprotein
cholesterol rose in men until the age of 65 and in women until the age
of 75; but after that age they declined at a rate of about 1% every
year. These changes were independent of changes in weight.
Age related macular degeneration is the most common cause of
blindness of recent onset in elderly people, but its natural course is
still poorly understood (Eye 1997;11:301-14). A study of
a cohort of elderly patients first examined in 1982 when aged 77-90
showed that a tenth had been blind when first seen and that when
re-examined in 1990 at the age of 84-97 this proportion had risen to a
fifth.
As the NHS comes under ever greater financial pressure, ever
more of the long term care of elderly people is being provided by the
independent sector. An editorial in Quality in Health Care
(1997;6:118-9) warns that the quality specifications in
contracts with health authorities are often not specific enough. It
calls for monitoring by a district-wide team funded through health and
social care budgets and including geriatricians, social workers,
therapists, community nurses, and general practitioners.
The success rate for corneal grafting declines with age, but
even in patients over the age of 80 the five year survival rates for
the grafts in a series in Australia were 63% for the most common
indication, pseudophakic bullous keratopathy, and 87% for corneal
scars (British Journal of Ophthalmology 1997;81:835-9).
The age of the donor had no effect on survival of the grafts - two
thirds of the donors were in their sixth decade or older and 6% were
over the age of 80.
Psychiatrists believe that old people who complain that
their memories are failing are as likely to be depressed as demented,
but a study in Amsterdam (British Journal of Psychiatry
1997;171:373-6) of 2114 patients found that poor memory was a
sound predictor of later dementia. Four years after an initial
examination 131 people had developed dementia. Those who had remained
normal were relatively young, scored high on the memory test, were
slightly more intelligent, and had lower depression scores.
Yeats described old, old men as having hands like claws and
knees twisted like thorn trees - a quotation that opens a review in
Annals of the Rheumatic Diseases (1997;56:578-85) of the
effects of aging on the musculoskeletal system. This emphasises the
benefits that can come from progressive physical training even in old
and frail people. It also argues that since preserving the strength of
the quadriceps muscles may lessen the risk of osteoarthritis of the
knee, middle aged people should be encouraged to think of preventive
muscle maintenance.
A case-control study in Nottingham of 487 patients over the age
of 60 who were admitted to hospital having bled from a peptic ulcer
found (predictably) that use of non-steroidal anti-inflammatory drugs
increased the risk and so did infection with Helicobacter pylori
(Gut 1997;41:459-62). However, the two risk
factors did not seem to interact. The authors conclude that their data
do not support the "growing tendency to eradicate H
pylori in patients taking non-steroidal drugs: only a clinical
trial can determine whether this is beneficial, valueless, or
harmful."
Depression in elderly people is often associated with
chronic progressive physical disease. A study in Liverpool followed up
82 patients who were both depressed and suffering from, on average, two
acute physical problems and three chronic health problems
(International Journal of Geriatric Psychiatry
1997;12:817-24). Those treated with fluoxetine were twice as
likely to have recovered from their depression in eight weeks than
those given placebo. The presence of even severe physical illness did
not seem to reduce the effectiveness of the drug.
Successful aging has three components, says an article in
The Gerontologist (1997;37:433-40). These are a low
probability of disease and related disability, high cognitive and
physical functional capacity, and active engagement in social
activities. Achieving these aims can be made more likely by a package
of past and present features of lifestyle: a good education and a
normal weight help, and so do regular exercise, having good lung
function, and being part of a social network. "Unto those that hath
shall be given."
Falls are so common in elderly people that the small fraction
that may be due to unrecognised syncope is still numerically important
(Postgraduate Medical Journal 1997;73:635-9). Even if
the patient denies having felt faint the possibility should be
considered that there may be a treatable cardiovascular cause for the
incident.
Symptoms of urinary incontinence commonly follow a diagnosis of
Parkinson's disease, stroke, dementia, depression, or congestive heart
failure - and increase the likelihood of admission to hospital
(Age and Ageing 1997;26:367-74). Incontinence has,
however, little influence on mortality.
Being over the age of 90 is not in itself depressing, according
to a study from Italy reported in the Journal of the American
Geriatrics Society (1997;45:1196-202). Tests of 84 healthy
Italians aged between 90 and 106 showed that only one fifth were
independent in their activities of daily living, but tests for
depression showed that it was no more common than in people much
younger.
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