":!: -' ' E
...,l .,'
.,l
.'..,. l.i.; i~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ .....
Decelerating the Aging Process Hildrus A. Poindexter, MD, PhD Washington, DC
Diseases whose incidence and prevalence are increased in the elderly and whose cytopathology, hormones, and immunogenesis differ, generally are included in the field of geriatrics. These conditions may be precipitated or accelerated in quantity or type by a wide variety of genetic and environmental factors. Chronological and progressive deterioration of selected cells, organs, and tissues, and their functions may occur without major specific pathology. These processes are referred to as senescence and its study, is gerontology. Geriatrics includes senility and diseases of the elderly. Terms associated with gerontology include benign agism or senescence, as a normal consequence of the aging processes common to all biological forms of life. The age period, 65 to 85 years, does not necessarily imply senility, but the normal chronological aging of an individual in an industrialized, urbanized society. This paper emphasizes recommendations for deceleration of the normal aging process. Since the species part of the classification, Homo sapiens, denotes mentation, wisdom, sagacity, and even prudence, emphasis will be on deceleration of the aging process as manifested in the central nervous system. That other systems also be considered as total homeostasis is essential to effective function of the cells of the central nervous system. Mentation is the raison d'etre for Homo sapiens.
An Overview of Aging Man at his potential best has 1.3 x 1012 brain cells and after age 50 there is a progressive decrease in quantity and function of these cells in highly industrialized urban environments. Support for this concept comes from direct observations of the aged over the years, from extrapolation of animal experiDr. Poindexter is Medical Director, US Public Health Service (Retired) and is currently Professor of the Department of Community Health and Family Practice, Howard University College of Medicine, Washington, DC. Requests for reprints should be addressed to Dr. Hildrus A. Poindexter, Department of Community Health and Family Practice, Howard University College of Medicine, Washington, DC 20059.
ments, and from comparative embryological and archaeological studies of the cranium and brain cell development through anthropological research. Many factors have been noted in age deceleration, the foremost being good nutrition of the brain, including diet, oxygen, and glucose. There is evidence that indicates that merely by living in the currently poluted environment, cells of the brain, heart, adrenals, kidneys, testes, and ovaries show deposits of insoluble or poorly soluble deris, such as lipofuscin pigment.' It has been observed further that comparable insoluble materials deposited in the spleen and lymph nodes will interfere with effective immunogenesis and in the elderly cause an increased susceptibility to nosocomial infections. Elimination of this foreign material may bb increased by promoting more rapid protein synthesis and cell replication. A proper protein diet promotes protein synthesis, the rate of which is decreased in the elderly. At birth, there are 17.4 gm of protein synthesized per kilogram of body weight. In the elderly, however,
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
there is a decrease to 6.9 gm/kg of body weight.' The rate of decline is accelerated as one ages. A proper diet tends to decelerate the process.
Recommendations for Decelerating Aging Proper Diet Maintenance of the correct diet for the person's physiological need for homeostasis is essential. There are 50 or more essential nutrients in the wellrounded human diet of which the elderly often take less than ten. This is due to a lack of incentive to eat rather than from economic factors. A proper diet contains adequate quantities of the essential amino acids which should be about 60 gm per day, especially from proteins rich in nucleic acids. From such a diet, RNA-DNA synthesis is most active and energy derived from adenosine triphosphate (ATP) for replication is effective. I Along with certain enzymes and histones, cell replication occurs in some organs and tissues and degeneration is retarded in others. If reasonable amounts of carbohydrates and unsaturated fats are taken regularly, the normal aging processes can be decelerated. Details of a gerontological diet will vary with cultural practices, but should include, if feasible, quantities of milk, fresh green vegetables, liver, onions, one egg twice a week, and sardines and other seafoods. The average elderly person, who does not engage in vigorous exercise, can maintain normal homeostasis with about 2,000 calories of food per day. Anemia and other conditions associated with malnutrition are common in the elderly. Malnutrition has a negative effect on social attitudes and behavior, immunity to microbial infections, mentation, productivity, and general homeostasis. Vitamins, minerals, and tracer elements are also important in the diet. Of the 18 vitamins, A, B, C, D, and K are 91
necessary. Some vitamin enthusiasts suggest others but for normal senescence, without specific diseases, this is the author's recommended list. When they are included regularly in a diet, by eating fresh fruits, meats, and dairy products, the aging process can be decelerated. The other 13 vitamins find their greatest uses in therapy of specific deficiencies and for maintaining normal homeostasis. All normal diets should include minerals such as sodium, calcium, and iron. The author's ranking of mineral requirements is: iron, calcium, phosphates, iodine, potassium, and sodium. Trace elements such as zinc, copper, cobalt, manganese, chrome, molybdenum, and the vanadium of seafood, have their advocates. All of these essential minerals may be obtained by a wellbalanced diet of vegetables, dairy and poultry products, meats, and seafood. Normally, there is no need for artificial minerals and vitamins in gerontology. In geriatrics, the regimen may be different. Several behavioral features may reduce the effectiveness of this diet, ie, nicotine absorption from cigarette smoking, alcohol consumption, and a variety of harmful central nervous system affinity drugs. Since constipation is a common feature in the aged, the diet should also contain adequate fiber. The blood cholesterol level plays a major role in promoting heart attacks in those under 55 years of age, but not in the "old-old" elderly.
Physical Exercise Regular and adjusted exercise under frequent medical review is essential to optimum homeostasis in the elderly as well as in younger people. There is a biological law that muscles and minds of mammals will deteriorate with prolonged disuse or nonuse. This must be kept in mind in planning hobbies and other activities for the elderly. Some form of employment or use of the physical and mental potentials still remaining should be planned. The only criterion is one's ability and eagerness to do physically, mentally, and socially useful work. Experiences of the elderly are valuable resources not to be cast off. There are considerable legislative acts, appropriations, and government agencies designed to use these valuable resources. Physical fitness is highly correlated with good mentation. Physical exercise reduces the replacement of 92
muscle cells by fat. The elderly will wither and "dry up" without refreshing contacts and knowledge that someone cares just as the grass will wither without rain. The elderly may slow down their pace, but they must not stop exercising. They may, also, accelerate their thoughts.
Avoid Social Isolation, Insulation, and Seclusion The elderly should not voluntarily seek or accept these conditions nor should the family or society forcibly impose these conditions on them. Isolation is physically and mentally harmful and may be reflected in diminished brain function. The elderly do not want to be "put on a shelf." They want to maintain relationships with their family and friends of different ages and different levels of mentation, ie, young adults and grandchildren. The elderly are not merely custodial problems to be sent to a nursing home or extended care facility to be "taken care of." The elderly do not want to be social "orphans." As emotional "orphans," they feel depressed. As cast-off orphans, they feel that nobody loves, wants, needs, or respects them. They feel lonesome and need empathy in its purest sense. In this state, these withered, faded, and unwanted older people often wish for death that comes far too slowly. The social practice of mandatory retirement and nursing home assignment of the elderly emphasizes the possible harmful effects of mandatoryage retirement. Fortunately, a reevaluation of the practice is taking place. It is within the midcareer and premature retirement group that much dementia, depression, and drug or alcohol abuse develops. Sleep is an important feature of health which should not be drug induced. The worst disease in existence is loneliness, ie, to feel that nobody loves or cares for you anymore. Laughter with and by the elderly is the best medicine. Remember the Biblical saying, "Cast me not off in my old age." Every youth should be encouraged to extend a hand to the elderly. Both will benefit. Those who have elderly clientele should emphasize that the noble influences of the elderly are more than secular or transient. These features of dignity and reflection may outlast one's physical being and become immortal by their influence on youth.
Community resources should be used as much as possible to supplement health care services to the elderly. They can help in communication, companionship, transportation, home visits, reassuring telephone calls, shopping assistance, etc. The time has come for Americans to re-evaluate human values. Far too often the value of a person is taken on: (1) physical agility and industrial productivity; (2) the beauty of the body; and (3) the state of affluence. Each of these has value but for Homo sapiens, added criteria should be emphasized; to name a few, respectability, equanimity, sageness in counsel, and prudence.
Hygiene Promote good personal hygiene, including mental hygiene and home sanitation. Many studies have shown the high positive correlation between good personal hygiene and home sanitation and good health. The greatest correlations are among pathological conditions related to the skin and those mucous membranes directly connected to the skin by orifices or cavities. Much of this is due to impairment of replication or skin repair in the aged. Several opportunistic microbes in an unhealthy environment take advantage of poor personal hygiene to colonize the skin and connecting cavities. Three areas of importance are: 1. Oral hygiene: Many of the elderly may be able to save or prolong the usefulness of their teeth at a period in life when osteoporosis is increased and the loss of natural dentation is accelerated. 2. Foot hygiene: Clinical diabetes mellitus is a common geriatric problem and peripheral neuropathy and gangrene, affecting the feet, are frequent and serious complications. Poor foot hygiene, including careless cutting of toenails, may accelerate this pathology. Good care should also be given to fingernails. 3. General body cleanliness: To reduce pyogenic and mycotic skin infections and make the body surface less susceptible to nosocomial infections associated with frequent visits to hospitals and clinics, a bath each day is a good practice.
Security Security covers economic security; secure and sanitary housing, security from assault and robbery in the home, streets, and parks, and security from a Continued on page 94
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
Continued from page 92
variety of preventable socioemotional factors. The stress of insecurity will influence blood pressure, tax one's heart, and promote antisocial behavior.
tab tsCm IelixirCv
Tender Loving Care (TLC) at Home and by Society
Summary of Prescribing Information Tablets: Contain codeine phosphate: No. 1-7.5 mg. (1/8 gr.): No. 2-15 mg. (1/4 gr.): No. 3-30 mg. (112 gr.): No. 4-60 mg. (1 gr.)-plus acetaminophen 300 mg. Elixir: Each 5 ml. cotntains 12 mg. codeine phosphate plus 120 mg. acetaminophen (alcohol 7%). *Waming: May be habit torming. Contraindicatlons: Hypersensitivity to acetaminophen or codeine. Warnings: Drug dependence. Codeine can produce drug dependence of the morphine type and may be abused. Dependence and tolerance may develop upon repeated administration: prescribe and administer with same caution appropriate to other oral narcotics. Subject to the Federal Controlled Substances Act. Usage in ambulatory patients: Caution patients that codeine may impair mental and/or physical abilities required for performance of potentially hazardous tasks such as driving a car or operating machinery. Interaction with other CNS depressants: Patients receiving other narcotic analgesics, general anesthetics, phenothiazines, other tranquilizers, sedative-hypnotics or other CNS depressants (including alcohol) with this drug may exhibit additive CNS depression. When such a combination is contemplated, reduce the dose of one or both agents. Usage in pregnancy: Safe use not established. Should not be used in pregnant women unless potential benefits outweigh possible hazards. Precautions: Head injury and increased intracranial pressure. Respiratory depressant effects of narcotics and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a pre-existing increase in intracranial pressure. Narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries. Acute abdominal conditions: Codeine or other narcotics may obscure the diagnosis or clinical course of acute abdominal conditions. Special risk patients: Administer with caution to certain patients such as the elderly or debilitated and those with severe impairment of hepatic or renal function, hypothyroidism. Addison's disease, and prostatic hypertrophy or urethral stricture Adverse Reactions: Most frequent: lightheadedness, dizziness, sedation, nausea and vomiting, more prominent in ambulatory than nonambulatory patients: some of these reactions may be alleviated if the patient lies down. Others: euphoria, dysphoria, constipation and pruritus. Drug Interactions: CNS depressant effect may be additive with that of other CNS depressants. See Warnings. For information on symptoms/treatment of overdosage, see full prescribing information. Full directions for use should be read before administering or prescribing. TYLENOL with Codeine tablets are manufactured by McNeil Laboratories Co., Dorado, Puerto Rico 00646. Caution Federal law prohibits dispensing without prescription. © McN 1979
06721
TLC is essential to the equanimity of the elderly, who is some instances are as dependent as children. All members of the community and society can and should make a contribution. The most important and least exploited power of our age is love power. Why not use it? Of course, love, justice, and respect should go hand in hand. We have repeated evidence that TLC can and will reawaken and remotivate neurological pathways and stimulate compensatory functions to damaged parts of the brain and affect behavior. TLC will decelerate vegetation of the elderly.
Private Physician Every elderly person should have a private physician or a suitable health infrastructure available and accessible to permit, at least, an annual physical examination. During these examinations, early presence of several of the more frequent degenerative diseases of aging could be identified at a time when they may best be managed or controlled. Delay in early diagnosis and proper management of the degenerative diseases reduces the chance for, and the effectiveness of, prevention of secondary manifestations, of cure, or of deceleration of the pathologic processes.
Any program for medical care of the elderly should include the family and landlord in the management. Physicians are urged to expand their knowledge of gerontology and geriatrics for the coming wave of those over 65 years of age, one out of five by year
2000.2.3 Marriage
b NEIL I McNE
94
|
McNEILAB, Inc., McNeil Laboratories,19034
FlortNWashington, Pa.
Stay married as long as possible. Try to find someone who is like-minded in religion, philosophy, X and intelligence. This gives the elderly a built-in sharer of frustrations and other social problems and contributes to equanimity. The couple should plan for a debtfree home or one with considerable equity by the time retirement age is reached.
Spiritual Equanimity Spiritual, here, is a broad term and includes ethical, literary, and religious values. Active progress toward the improvement of our moral, spiritual, and intellectual life contributes to equanimity. Psychosocial equilibrium is very important to Homo sapiens. An humanitarian attitude is a good contribution to peace of mind. One does not have to be a metaphysician to enjoy the concept of enlarging one's life beyond the current existence. This can be done by several means without physical immortality. Is one's happiness of life push or pull? There is discussion on whether current man is the product ofpush by evolution (survival by physical adaptation) or pull by reflection on creation and spiritual inspiration with belief in theology and belief in miracles. Both may be viable alternatives and should be at least analyzed. There are few, if any, absolute truths or sacrosanct concepts in the known world. Remember, the decelerating features are not merely designed to prolong one's life but also to make life more "meaningful and useful."
Transportation Safe and economical transportation should be available and accessible, not merely to get to and from medical facilities but also to church, market, parks, and other recreational places. A wholesome recreational and working environment may contribute to the deceleration of the aging.
Avoid Predictable Stress Situations Prepare for retirement before retirement. Take essential immunizations against the severe infectious diseases of the elderly. Avoid psychological stress situations when possible. Psychological stress can further damage the thymus and other glands of the immune system. Seek counsel before entering contracts. Leave shrewd business deals to younger members of the family. Keep and accept limited responsiblities as long as possible, especially around the house. At age 65 + 10 years, one's neurocytological basis for clear mentation begins to wane. This should be a time and signal to reduce those situations requring taxing mentation. However, the waning can be decelerated by a variety of environmental factors. Continued on next page
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
Continued from preceding page
Legal Matters Obtain legal counsel on matters of will, bequests, property disposal, and related matters.
Exposure Avoid unnecessary exposure to chemicals that may damage nonreplicable cells, tissues, or organs such as the brain, retina, heart muscle, and nephrons of the kidneys. As people age, lost muscle cells are replaced by fat cells.
Drug Therapy When chemical drug therapy is indicated to counteract senility and presenile dementia, one may try bishydroxycoumarin (Dicumarol), on the theory that blood sludging or red blood corpuscle aggregation may be a factor in the regression of senility. Dicumarol may help in increasing blood flow to the central nervous system.
Thanatology and Thanatopsis A paper that focuses on the deceleration of the aging is obligated to say something about the biological ending of the living process. Only four percent of senescent persons are senile to the point of unreality. They realize that they are mortal men and according to the saying of St. Paul in his letter to the Hebrews, 9:27, "That it is appointed to man once to die ...." The elderly know that there will be an end of their mortal selves. They accept this fact and adjust to the prospect of a life shorter than Methusalah's. They do not want to pollute the environment forever. They do, however, want to live well, get good medical care while alive, and die with dignity.
Conclusion As a septuagenarian and member of the Committee on Aging of the Medical Society of DC, a committee whose focus is on gerontology (aging without disease) and geriatrics (diseases in the elderly), I have had the opportunity to
talk with many elderly persons over the last ten years. The elderly are a fairly nice and reasonable group with which to converse. They talk freely about death but do not fear death. They dread the thought and pain of dying and being buried in a cold dark grave, where they may be abandoned and forgotten. We, in the medical profession, should keep these topics in mind when dealing with the elderly. They may want to talk about them, and good communication will promote equanimity in the elderly. The clinician should reflect on marantology and investigate the hospice practice. Acknowledgements The author wishes to express appreciation to Miss Patricia A. Cooksey and Mrs. Carroll L. Fitzhugh for their clerical support.
Literature Cited 1. Timiras PS: Developmental Physiology and Aging. New York, Macmillan, 1972, pp 441, 435-440, 458-460 2. Health, United States, 1976-1977. In Department of Health, Education, and Welfare. Public Health Service. (Washington, DC): DHEW Publication No. (HRA) 77-1232. Government Printing Office, 1978, pp 3-26 3. Butler RN: The doctor and the aged patient. Hosp Pract 13:99-106, 1978
James Honored at Testimonial Dinner Dr. Reginald G. James (MD, Howard, '37), of Washington, DC, was honored at a testimonial dinner by the Office of Continuing Medical Education of Howard University's College of Medicine on Wednesday, May 3, 1978, at the Hyatt Regency Hotel in Washington. Born in Richmond, Virginia, on June 14, 1909, Dr. James attended public schools there and received the BS degree from Virginia Union University in 1933 and the MD degree from Howard University in 1937. He completed internships at Homer G. Phillips and Freedmen's Hospitals. Following a postgraduate course in venereal disease at Freedmen's Hospital, he served as Venereal Disease Clinician in Macon County, Alabama, from 1939 to 1941. This program was supported by the Julius Rosenwald Fund. At the termination of this tour, Dr. James was medical officer at the Tuskegee Veterans Administration Hospital from 1941
to 1943. In February of 1943, he was appointed associate medical officer with the United States Public Health Service assigned to Washington, DC. In December of the same year, he was appointed to the rank of assistant surgeon in the Reserve Corps, Venereal Disease Division. In November 1944, he was promoted to the rank of assistant surgeon with the USPHS Reserve Corps. In 1945, Dr. James was assigned to the Johns Hopkins University Hospital where he was granted a Rockefeller Foundation Fellowship to attend the Johns Hopkins School of Hygiene and Public Health. He received the degree of Master of Public 14ealth from Johns Hopkins in 1946. In this same year, he resigned from the US Public Health Service to begin private practice in the Deanwood community of Washington, DC, where he presently serves as family practitioner. While in private practice, Dr. James
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
served as a medical officer at the Industrial Home School for Colored Children in Blue Plains, DC, in 1949. In 1955 this institution became Junior Village and Dr. James continued to serve there until 1970 at which time he became full-time medical officer at the Bureau of Hearings and Appeals of the Social Security Administration. In 1973 he became Acting Chief Medical Officer. He retired in April 1978. Dr. James is a member of the National Medical Association, the American Medical Association, the MedicoChirurgical Society of the District of Columbia, the DC Medical Society, the Daniel Hale Williams Medical Reading Club, the Southern Medical Association, the American Academy of Family Physicians, and the Alpha Phi Alpha Fraternity. Dr. James is married to the former Sadie Harris. They have two children, Janice and Reginald.
95
...,l .,'
.,l
.'..,. l.i.; i~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ .....
Decelerating the Aging Process Hildrus A. Poindexter, MD, PhD Washington, DC
Diseases whose incidence and prevalence are increased in the elderly and whose cytopathology, hormones, and immunogenesis differ, generally are included in the field of geriatrics. These conditions may be precipitated or accelerated in quantity or type by a wide variety of genetic and environmental factors. Chronological and progressive deterioration of selected cells, organs, and tissues, and their functions may occur without major specific pathology. These processes are referred to as senescence and its study, is gerontology. Geriatrics includes senility and diseases of the elderly. Terms associated with gerontology include benign agism or senescence, as a normal consequence of the aging processes common to all biological forms of life. The age period, 65 to 85 years, does not necessarily imply senility, but the normal chronological aging of an individual in an industrialized, urbanized society. This paper emphasizes recommendations for deceleration of the normal aging process. Since the species part of the classification, Homo sapiens, denotes mentation, wisdom, sagacity, and even prudence, emphasis will be on deceleration of the aging process as manifested in the central nervous system. That other systems also be considered as total homeostasis is essential to effective function of the cells of the central nervous system. Mentation is the raison d'etre for Homo sapiens.
An Overview of Aging Man at his potential best has 1.3 x 1012 brain cells and after age 50 there is a progressive decrease in quantity and function of these cells in highly industrialized urban environments. Support for this concept comes from direct observations of the aged over the years, from extrapolation of animal experiDr. Poindexter is Medical Director, US Public Health Service (Retired) and is currently Professor of the Department of Community Health and Family Practice, Howard University College of Medicine, Washington, DC. Requests for reprints should be addressed to Dr. Hildrus A. Poindexter, Department of Community Health and Family Practice, Howard University College of Medicine, Washington, DC 20059.
ments, and from comparative embryological and archaeological studies of the cranium and brain cell development through anthropological research. Many factors have been noted in age deceleration, the foremost being good nutrition of the brain, including diet, oxygen, and glucose. There is evidence that indicates that merely by living in the currently poluted environment, cells of the brain, heart, adrenals, kidneys, testes, and ovaries show deposits of insoluble or poorly soluble deris, such as lipofuscin pigment.' It has been observed further that comparable insoluble materials deposited in the spleen and lymph nodes will interfere with effective immunogenesis and in the elderly cause an increased susceptibility to nosocomial infections. Elimination of this foreign material may bb increased by promoting more rapid protein synthesis and cell replication. A proper protein diet promotes protein synthesis, the rate of which is decreased in the elderly. At birth, there are 17.4 gm of protein synthesized per kilogram of body weight. In the elderly, however,
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
there is a decrease to 6.9 gm/kg of body weight.' The rate of decline is accelerated as one ages. A proper diet tends to decelerate the process.
Recommendations for Decelerating Aging Proper Diet Maintenance of the correct diet for the person's physiological need for homeostasis is essential. There are 50 or more essential nutrients in the wellrounded human diet of which the elderly often take less than ten. This is due to a lack of incentive to eat rather than from economic factors. A proper diet contains adequate quantities of the essential amino acids which should be about 60 gm per day, especially from proteins rich in nucleic acids. From such a diet, RNA-DNA synthesis is most active and energy derived from adenosine triphosphate (ATP) for replication is effective. I Along with certain enzymes and histones, cell replication occurs in some organs and tissues and degeneration is retarded in others. If reasonable amounts of carbohydrates and unsaturated fats are taken regularly, the normal aging processes can be decelerated. Details of a gerontological diet will vary with cultural practices, but should include, if feasible, quantities of milk, fresh green vegetables, liver, onions, one egg twice a week, and sardines and other seafoods. The average elderly person, who does not engage in vigorous exercise, can maintain normal homeostasis with about 2,000 calories of food per day. Anemia and other conditions associated with malnutrition are common in the elderly. Malnutrition has a negative effect on social attitudes and behavior, immunity to microbial infections, mentation, productivity, and general homeostasis. Vitamins, minerals, and tracer elements are also important in the diet. Of the 18 vitamins, A, B, C, D, and K are 91
necessary. Some vitamin enthusiasts suggest others but for normal senescence, without specific diseases, this is the author's recommended list. When they are included regularly in a diet, by eating fresh fruits, meats, and dairy products, the aging process can be decelerated. The other 13 vitamins find their greatest uses in therapy of specific deficiencies and for maintaining normal homeostasis. All normal diets should include minerals such as sodium, calcium, and iron. The author's ranking of mineral requirements is: iron, calcium, phosphates, iodine, potassium, and sodium. Trace elements such as zinc, copper, cobalt, manganese, chrome, molybdenum, and the vanadium of seafood, have their advocates. All of these essential minerals may be obtained by a wellbalanced diet of vegetables, dairy and poultry products, meats, and seafood. Normally, there is no need for artificial minerals and vitamins in gerontology. In geriatrics, the regimen may be different. Several behavioral features may reduce the effectiveness of this diet, ie, nicotine absorption from cigarette smoking, alcohol consumption, and a variety of harmful central nervous system affinity drugs. Since constipation is a common feature in the aged, the diet should also contain adequate fiber. The blood cholesterol level plays a major role in promoting heart attacks in those under 55 years of age, but not in the "old-old" elderly.
Physical Exercise Regular and adjusted exercise under frequent medical review is essential to optimum homeostasis in the elderly as well as in younger people. There is a biological law that muscles and minds of mammals will deteriorate with prolonged disuse or nonuse. This must be kept in mind in planning hobbies and other activities for the elderly. Some form of employment or use of the physical and mental potentials still remaining should be planned. The only criterion is one's ability and eagerness to do physically, mentally, and socially useful work. Experiences of the elderly are valuable resources not to be cast off. There are considerable legislative acts, appropriations, and government agencies designed to use these valuable resources. Physical fitness is highly correlated with good mentation. Physical exercise reduces the replacement of 92
muscle cells by fat. The elderly will wither and "dry up" without refreshing contacts and knowledge that someone cares just as the grass will wither without rain. The elderly may slow down their pace, but they must not stop exercising. They may, also, accelerate their thoughts.
Avoid Social Isolation, Insulation, and Seclusion The elderly should not voluntarily seek or accept these conditions nor should the family or society forcibly impose these conditions on them. Isolation is physically and mentally harmful and may be reflected in diminished brain function. The elderly do not want to be "put on a shelf." They want to maintain relationships with their family and friends of different ages and different levels of mentation, ie, young adults and grandchildren. The elderly are not merely custodial problems to be sent to a nursing home or extended care facility to be "taken care of." The elderly do not want to be social "orphans." As emotional "orphans," they feel depressed. As cast-off orphans, they feel that nobody loves, wants, needs, or respects them. They feel lonesome and need empathy in its purest sense. In this state, these withered, faded, and unwanted older people often wish for death that comes far too slowly. The social practice of mandatory retirement and nursing home assignment of the elderly emphasizes the possible harmful effects of mandatoryage retirement. Fortunately, a reevaluation of the practice is taking place. It is within the midcareer and premature retirement group that much dementia, depression, and drug or alcohol abuse develops. Sleep is an important feature of health which should not be drug induced. The worst disease in existence is loneliness, ie, to feel that nobody loves or cares for you anymore. Laughter with and by the elderly is the best medicine. Remember the Biblical saying, "Cast me not off in my old age." Every youth should be encouraged to extend a hand to the elderly. Both will benefit. Those who have elderly clientele should emphasize that the noble influences of the elderly are more than secular or transient. These features of dignity and reflection may outlast one's physical being and become immortal by their influence on youth.
Community resources should be used as much as possible to supplement health care services to the elderly. They can help in communication, companionship, transportation, home visits, reassuring telephone calls, shopping assistance, etc. The time has come for Americans to re-evaluate human values. Far too often the value of a person is taken on: (1) physical agility and industrial productivity; (2) the beauty of the body; and (3) the state of affluence. Each of these has value but for Homo sapiens, added criteria should be emphasized; to name a few, respectability, equanimity, sageness in counsel, and prudence.
Hygiene Promote good personal hygiene, including mental hygiene and home sanitation. Many studies have shown the high positive correlation between good personal hygiene and home sanitation and good health. The greatest correlations are among pathological conditions related to the skin and those mucous membranes directly connected to the skin by orifices or cavities. Much of this is due to impairment of replication or skin repair in the aged. Several opportunistic microbes in an unhealthy environment take advantage of poor personal hygiene to colonize the skin and connecting cavities. Three areas of importance are: 1. Oral hygiene: Many of the elderly may be able to save or prolong the usefulness of their teeth at a period in life when osteoporosis is increased and the loss of natural dentation is accelerated. 2. Foot hygiene: Clinical diabetes mellitus is a common geriatric problem and peripheral neuropathy and gangrene, affecting the feet, are frequent and serious complications. Poor foot hygiene, including careless cutting of toenails, may accelerate this pathology. Good care should also be given to fingernails. 3. General body cleanliness: To reduce pyogenic and mycotic skin infections and make the body surface less susceptible to nosocomial infections associated with frequent visits to hospitals and clinics, a bath each day is a good practice.
Security Security covers economic security; secure and sanitary housing, security from assault and robbery in the home, streets, and parks, and security from a Continued on page 94
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
Continued from page 92
variety of preventable socioemotional factors. The stress of insecurity will influence blood pressure, tax one's heart, and promote antisocial behavior.
tab tsCm IelixirCv
Tender Loving Care (TLC) at Home and by Society
Summary of Prescribing Information Tablets: Contain codeine phosphate: No. 1-7.5 mg. (1/8 gr.): No. 2-15 mg. (1/4 gr.): No. 3-30 mg. (112 gr.): No. 4-60 mg. (1 gr.)-plus acetaminophen 300 mg. Elixir: Each 5 ml. cotntains 12 mg. codeine phosphate plus 120 mg. acetaminophen (alcohol 7%). *Waming: May be habit torming. Contraindicatlons: Hypersensitivity to acetaminophen or codeine. Warnings: Drug dependence. Codeine can produce drug dependence of the morphine type and may be abused. Dependence and tolerance may develop upon repeated administration: prescribe and administer with same caution appropriate to other oral narcotics. Subject to the Federal Controlled Substances Act. Usage in ambulatory patients: Caution patients that codeine may impair mental and/or physical abilities required for performance of potentially hazardous tasks such as driving a car or operating machinery. Interaction with other CNS depressants: Patients receiving other narcotic analgesics, general anesthetics, phenothiazines, other tranquilizers, sedative-hypnotics or other CNS depressants (including alcohol) with this drug may exhibit additive CNS depression. When such a combination is contemplated, reduce the dose of one or both agents. Usage in pregnancy: Safe use not established. Should not be used in pregnant women unless potential benefits outweigh possible hazards. Precautions: Head injury and increased intracranial pressure. Respiratory depressant effects of narcotics and their capacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a pre-existing increase in intracranial pressure. Narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries. Acute abdominal conditions: Codeine or other narcotics may obscure the diagnosis or clinical course of acute abdominal conditions. Special risk patients: Administer with caution to certain patients such as the elderly or debilitated and those with severe impairment of hepatic or renal function, hypothyroidism. Addison's disease, and prostatic hypertrophy or urethral stricture Adverse Reactions: Most frequent: lightheadedness, dizziness, sedation, nausea and vomiting, more prominent in ambulatory than nonambulatory patients: some of these reactions may be alleviated if the patient lies down. Others: euphoria, dysphoria, constipation and pruritus. Drug Interactions: CNS depressant effect may be additive with that of other CNS depressants. See Warnings. For information on symptoms/treatment of overdosage, see full prescribing information. Full directions for use should be read before administering or prescribing. TYLENOL with Codeine tablets are manufactured by McNeil Laboratories Co., Dorado, Puerto Rico 00646. Caution Federal law prohibits dispensing without prescription. © McN 1979
06721
TLC is essential to the equanimity of the elderly, who is some instances are as dependent as children. All members of the community and society can and should make a contribution. The most important and least exploited power of our age is love power. Why not use it? Of course, love, justice, and respect should go hand in hand. We have repeated evidence that TLC can and will reawaken and remotivate neurological pathways and stimulate compensatory functions to damaged parts of the brain and affect behavior. TLC will decelerate vegetation of the elderly.
Private Physician Every elderly person should have a private physician or a suitable health infrastructure available and accessible to permit, at least, an annual physical examination. During these examinations, early presence of several of the more frequent degenerative diseases of aging could be identified at a time when they may best be managed or controlled. Delay in early diagnosis and proper management of the degenerative diseases reduces the chance for, and the effectiveness of, prevention of secondary manifestations, of cure, or of deceleration of the pathologic processes.
Any program for medical care of the elderly should include the family and landlord in the management. Physicians are urged to expand their knowledge of gerontology and geriatrics for the coming wave of those over 65 years of age, one out of five by year
2000.2.3 Marriage
b NEIL I McNE
94
|
McNEILAB, Inc., McNeil Laboratories,19034
FlortNWashington, Pa.
Stay married as long as possible. Try to find someone who is like-minded in religion, philosophy, X and intelligence. This gives the elderly a built-in sharer of frustrations and other social problems and contributes to equanimity. The couple should plan for a debtfree home or one with considerable equity by the time retirement age is reached.
Spiritual Equanimity Spiritual, here, is a broad term and includes ethical, literary, and religious values. Active progress toward the improvement of our moral, spiritual, and intellectual life contributes to equanimity. Psychosocial equilibrium is very important to Homo sapiens. An humanitarian attitude is a good contribution to peace of mind. One does not have to be a metaphysician to enjoy the concept of enlarging one's life beyond the current existence. This can be done by several means without physical immortality. Is one's happiness of life push or pull? There is discussion on whether current man is the product ofpush by evolution (survival by physical adaptation) or pull by reflection on creation and spiritual inspiration with belief in theology and belief in miracles. Both may be viable alternatives and should be at least analyzed. There are few, if any, absolute truths or sacrosanct concepts in the known world. Remember, the decelerating features are not merely designed to prolong one's life but also to make life more "meaningful and useful."
Transportation Safe and economical transportation should be available and accessible, not merely to get to and from medical facilities but also to church, market, parks, and other recreational places. A wholesome recreational and working environment may contribute to the deceleration of the aging.
Avoid Predictable Stress Situations Prepare for retirement before retirement. Take essential immunizations against the severe infectious diseases of the elderly. Avoid psychological stress situations when possible. Psychological stress can further damage the thymus and other glands of the immune system. Seek counsel before entering contracts. Leave shrewd business deals to younger members of the family. Keep and accept limited responsiblities as long as possible, especially around the house. At age 65 + 10 years, one's neurocytological basis for clear mentation begins to wane. This should be a time and signal to reduce those situations requring taxing mentation. However, the waning can be decelerated by a variety of environmental factors. Continued on next page
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
Continued from preceding page
Legal Matters Obtain legal counsel on matters of will, bequests, property disposal, and related matters.
Exposure Avoid unnecessary exposure to chemicals that may damage nonreplicable cells, tissues, or organs such as the brain, retina, heart muscle, and nephrons of the kidneys. As people age, lost muscle cells are replaced by fat cells.
Drug Therapy When chemical drug therapy is indicated to counteract senility and presenile dementia, one may try bishydroxycoumarin (Dicumarol), on the theory that blood sludging or red blood corpuscle aggregation may be a factor in the regression of senility. Dicumarol may help in increasing blood flow to the central nervous system.
Thanatology and Thanatopsis A paper that focuses on the deceleration of the aging is obligated to say something about the biological ending of the living process. Only four percent of senescent persons are senile to the point of unreality. They realize that they are mortal men and according to the saying of St. Paul in his letter to the Hebrews, 9:27, "That it is appointed to man once to die ...." The elderly know that there will be an end of their mortal selves. They accept this fact and adjust to the prospect of a life shorter than Methusalah's. They do not want to pollute the environment forever. They do, however, want to live well, get good medical care while alive, and die with dignity.
Conclusion As a septuagenarian and member of the Committee on Aging of the Medical Society of DC, a committee whose focus is on gerontology (aging without disease) and geriatrics (diseases in the elderly), I have had the opportunity to
talk with many elderly persons over the last ten years. The elderly are a fairly nice and reasonable group with which to converse. They talk freely about death but do not fear death. They dread the thought and pain of dying and being buried in a cold dark grave, where they may be abandoned and forgotten. We, in the medical profession, should keep these topics in mind when dealing with the elderly. They may want to talk about them, and good communication will promote equanimity in the elderly. The clinician should reflect on marantology and investigate the hospice practice. Acknowledgements The author wishes to express appreciation to Miss Patricia A. Cooksey and Mrs. Carroll L. Fitzhugh for their clerical support.
Literature Cited 1. Timiras PS: Developmental Physiology and Aging. New York, Macmillan, 1972, pp 441, 435-440, 458-460 2. Health, United States, 1976-1977. In Department of Health, Education, and Welfare. Public Health Service. (Washington, DC): DHEW Publication No. (HRA) 77-1232. Government Printing Office, 1978, pp 3-26 3. Butler RN: The doctor and the aged patient. Hosp Pract 13:99-106, 1978
James Honored at Testimonial Dinner Dr. Reginald G. James (MD, Howard, '37), of Washington, DC, was honored at a testimonial dinner by the Office of Continuing Medical Education of Howard University's College of Medicine on Wednesday, May 3, 1978, at the Hyatt Regency Hotel in Washington. Born in Richmond, Virginia, on June 14, 1909, Dr. James attended public schools there and received the BS degree from Virginia Union University in 1933 and the MD degree from Howard University in 1937. He completed internships at Homer G. Phillips and Freedmen's Hospitals. Following a postgraduate course in venereal disease at Freedmen's Hospital, he served as Venereal Disease Clinician in Macon County, Alabama, from 1939 to 1941. This program was supported by the Julius Rosenwald Fund. At the termination of this tour, Dr. James was medical officer at the Tuskegee Veterans Administration Hospital from 1941
to 1943. In February of 1943, he was appointed associate medical officer with the United States Public Health Service assigned to Washington, DC. In December of the same year, he was appointed to the rank of assistant surgeon in the Reserve Corps, Venereal Disease Division. In November 1944, he was promoted to the rank of assistant surgeon with the USPHS Reserve Corps. In 1945, Dr. James was assigned to the Johns Hopkins University Hospital where he was granted a Rockefeller Foundation Fellowship to attend the Johns Hopkins School of Hygiene and Public Health. He received the degree of Master of Public 14ealth from Johns Hopkins in 1946. In this same year, he resigned from the US Public Health Service to begin private practice in the Deanwood community of Washington, DC, where he presently serves as family practitioner. While in private practice, Dr. James
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 1, 1979
served as a medical officer at the Industrial Home School for Colored Children in Blue Plains, DC, in 1949. In 1955 this institution became Junior Village and Dr. James continued to serve there until 1970 at which time he became full-time medical officer at the Bureau of Hearings and Appeals of the Social Security Administration. In 1973 he became Acting Chief Medical Officer. He retired in April 1978. Dr. James is a member of the National Medical Association, the American Medical Association, the MedicoChirurgical Society of the District of Columbia, the DC Medical Society, the Daniel Hale Williams Medical Reading Club, the Southern Medical Association, the American Academy of Family Physicians, and the Alpha Phi Alpha Fraternity. Dr. James is married to the former Sadie Harris. They have two children, Janice and Reginald.
95
