Vol. XXIII, No.3 Printed in U.S.A.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Copyright © 1975 by the American Geriatrics Society
Psychosomatic Rehabilitation of Elderly Persons ILONA HUTTERER, MD* and ZSUZSANNA DENES, MD**
National Institute of Medical Experts, Budapest, Hungaryt ABSTRACT: The psychosomatic rehabilitation of the elderly is an important task from both social and economic viewpoints. For psychic rehabilitation, moderate activity and the playing of games (such as chess, dominoes or cards) are recommended. Based on experiences with a group of 50 persons of the 70·90 age group, bridge playing is an especially desirable form of recreation. For somatic rehabilitation, physical exercise is a valuable aid, based on experiences with 338 partially disabled patients of the 51-81+ age group. dition. It is important that the aged person should feel that he has a position in society, that he has a task to perform, and that he is needed. In addition to work, he requires recreation, books, music and play. "Homo ludens" is· valid forever.
Healthy old people are in the best interest of both society and the national economy. In addition to prolongation of life, it is essential to provide meaning to life for the aged. The young and middle-aged are capable of productive work if the care of elderly helpless relatives does not weigh heavily on them or if the healthy "aged young" (1, 2) can take over most of the housework and care of the grandchildren. The dependent pensioner, even if leading a secluded life, needs some degree of social welfare (e.g., home care or continuous hospital care) if he is to keep well psychomatically and thereby lighten the burden of the overall economy. Hospital beds should be reserved for those who need them most-the seriously ill. We can do much to maintain a healthy psyche for the elderly. Occupational therapy in accordance with the subject's age and fitness was first introduced here by the farmers' cooperative (3). They recognized the significance of activity for the maintenance of health. Work should be provided for the elderly in a rhythmic apportionment and at a slower rate than during the years preceding pensioning, at a level compatible with the psychosomatic con-
PSYCHOSOMATIC HEALTH
The role of play The famous Hungarian poet Attila Jozsef said: "I do not like those who cannot play." Play for the elderly? This might include such games as chess, dominoes, or cards. According to Talleyrand, if we want to have a nice old age we have to learn to play cards. Advocating the same view, a 72-year-old woman physician prepared herself for old age by learning to play bridge .while active as chief of the medical expert service; at age 77 she is cheerful and healthy, and continues to play bridge in her spare time. Bridge. We studied 50 persons of the 70-90 age group who were of the same educational level. They played bridge (some of them since the age of 60) and it seemed to have practically an analgesic effect. For instance, a 90-year-old woman with severe spondylarthrosis took large quantities of analgesic drugs with little effect; when she played bridge, however, she had no pain. Among our aged subjects, bridge playing represents a real bridge to life. For them, to be
* Chief Surgeon of the Surgical Committee of the First Instance. ** Laboratory, Chief Physician. Address for correspondence: Zsuzsanna Denes, MD. Lab. Chief, Central Laboratory, Orszagos Orvosszakertoi Intezet, Budapest VIII. Mezo Imre UT 19/A, Hungary. t National Director General: Dr. Gabor Borsanyi. 137
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Vol. XXIII
present at a game of cards gives a feeling of importance because, if one of them should be absent, it would be impossible to make up a party. The "conscience of bridge" drives them to be present whether it rains or snows. Even if they have a family, they feel cosier with their fellow card players because they are of the same age and their memories of the past are identical. The harmony among bridge players is surprising. The news that one of them is ill spreads fast among the partners, and they hasten to give every assistance to the person in trouble. Bridge playing is also appropriate for people who are hard of hearing. It is enough to understand the bidding, and in this respect the partners are tolerant. According to our observations in this study, bridge playing is an excellent occupation for maintaining good psychic health in the aged (4,
During active exercise the muscular system exerts a pumping action which sends the blood toward the heart. At the same time the carbon dioxide and lactic acid which develop during muscular action shift the muscular pH toward acidity. This results in vascular dilatation. In senescence, rapid deterioration and slowed anabolism result in atrophy. Regular exercise delays atrophy and degeneration, and aids in the regeneration of injured tissues. Thus, for the aged, it acts as a remedy. "Dosage. " If exercise acts as a remedy, then it should be administered in individual dosage schedules. Moreover, just as improvement may follow appropriate dosage, so may harm follow a dosage that is too high. Overdosage means overstrain, which may activate disease (e.g., cardiac decompensation) in the elderly.
5).
Physical exercise for the partially disabled elderly
The role of gymnastics Plato observed the interdependence of soul and body. Man is imperfect if he cares only for his soul and allows his body to be torpid. One of the forms of body culture is gymnastics, for the maintenance and development of the intrinsic values of the human body. Even infants need gymnastics (6). Rhythmic physical exercise performed in a cheerful mood is also desirable in senescence. It has special significance during the presenium for prevention of the atrophy and articular restriction so characteristic of old age. Physical exercise improves blood circulation and reduces the tendency toward obesity. This form of preparation for old age lessens the impact of senescence. Gymnastic exercise for a few minutes daily is valuable therapy in all periods of life. It not only improves the physical condition by enhancing mobility and physical appearance, but helps the subject to endure mental stress and to combat disease. One aim of physical exercise is to mobilize restricted joints. Limbering-up exercise helps the patient to meet the motion requirements of everyday life. Physical exercise is the functional stimulus of the organs of locomotion. It increases intermediary and respiratory metabolism, enhances blood circulation and intestinal activity, prevents maldistribution of fat, and increases mobility of the joints. Its general effect is physical and mental refreshment.
138
We have observed the effect of physical exercise in 338 patients over the age of 50. The age distribution was as follows: 231 subjects in the 51-60 age group, 70 in the 61-70 group, 34 in the 71-80 group, and 3 in the 81 + group. There were 239 females and 99 males. Their locomotory disabilities included spondylosis, polyarteritis, polyarthrosis, periarteritis humeroscapularis, osteoporosis, post-traumatic conditions, and pes planus. Physical exercise had a favorable effect in every case, on both the local and the general condition. The patients were pleased with the slightest improvement and they felt extremely well. As movement became easier, they were less in need of assistance and thus they became more self-confident-a significant factor in the life of the aged doomed to passivity. Physical exercise reduces contractures and thus, pain. Old patients are often surprised to note that a previously rigid shoulder or ankle joint can be moved. They are better able to take care of themselves and acquire a feeling of security and self-assurance; as a consequence, depression disappears. The favorable psychic effect of improved mobility is unquestionable. Even though complete recovery from limitation of motion cannot always be achieved, the aged person is happy with a degree of improvement that enables him to carry. out the activities of daily living. The following is an example: A 67-year-old woman had periarteritis humero-scapularis. For six months her right
March 1975
PSYCHOSOMATIC REHABILITATION OF ELDERLY PERSONS
shoulder had been virtually immobile. She could not dress or comb her hair, and could eat only with difficulty. She was depressed, partly because of the pain and partly because of her inability to provide for herself. In addition, she could not care for her grandchild. Previously she had managed the cooking and housework, but now these activities were impossible. With appropriate shoulder and general exercises, the shoulder contracture gradually improved, as did her mood and general condition. As she was able to resume her former activities, her self-assurance and peace of mind returned. It is never too late to start physical exercise and there are virtually no contraindications to moderate amounts, individually determined. Certain forms of exercise (e.g., respiratory) may be employed even in seriously ill bed-
ridden patients. The results are always beneficial, and this encourages the patient to continue with the program.
Acknowledgments We wish to thank Dr. Gabor Borsanyi, National Director-General, for supporting our study, and Mrs. I. Palese, technical co-worker, for valuable assistance. REFERENCES 1. Denes Zs: Z Alternsforsch 21: 367, 1969. 2. Denes Zs: Z Alternsforsch 26: 67, 1972. 3. Szarvas A: Contribution at the Scientific Session of the Hungarian Society of Gerontology, Budapest, May 7, 1974. 4. Denes Zs: Rev Espan Gerontol 2: 155,1973. 5. Lang T: Magy Nemz, January 5, 1974, p. 7. 6. Sasdi Wiesenberg W: A Jlitekos Torna. Playful Gimnastics. Budapest, Edition Medicina, 1972.
139
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Copyright © 1975 by the American Geriatrics Society
Psychosomatic Rehabilitation of Elderly Persons ILONA HUTTERER, MD* and ZSUZSANNA DENES, MD**
National Institute of Medical Experts, Budapest, Hungaryt ABSTRACT: The psychosomatic rehabilitation of the elderly is an important task from both social and economic viewpoints. For psychic rehabilitation, moderate activity and the playing of games (such as chess, dominoes or cards) are recommended. Based on experiences with a group of 50 persons of the 70·90 age group, bridge playing is an especially desirable form of recreation. For somatic rehabilitation, physical exercise is a valuable aid, based on experiences with 338 partially disabled patients of the 51-81+ age group. dition. It is important that the aged person should feel that he has a position in society, that he has a task to perform, and that he is needed. In addition to work, he requires recreation, books, music and play. "Homo ludens" is· valid forever.
Healthy old people are in the best interest of both society and the national economy. In addition to prolongation of life, it is essential to provide meaning to life for the aged. The young and middle-aged are capable of productive work if the care of elderly helpless relatives does not weigh heavily on them or if the healthy "aged young" (1, 2) can take over most of the housework and care of the grandchildren. The dependent pensioner, even if leading a secluded life, needs some degree of social welfare (e.g., home care or continuous hospital care) if he is to keep well psychomatically and thereby lighten the burden of the overall economy. Hospital beds should be reserved for those who need them most-the seriously ill. We can do much to maintain a healthy psyche for the elderly. Occupational therapy in accordance with the subject's age and fitness was first introduced here by the farmers' cooperative (3). They recognized the significance of activity for the maintenance of health. Work should be provided for the elderly in a rhythmic apportionment and at a slower rate than during the years preceding pensioning, at a level compatible with the psychosomatic con-
PSYCHOSOMATIC HEALTH
The role of play The famous Hungarian poet Attila Jozsef said: "I do not like those who cannot play." Play for the elderly? This might include such games as chess, dominoes, or cards. According to Talleyrand, if we want to have a nice old age we have to learn to play cards. Advocating the same view, a 72-year-old woman physician prepared herself for old age by learning to play bridge .while active as chief of the medical expert service; at age 77 she is cheerful and healthy, and continues to play bridge in her spare time. Bridge. We studied 50 persons of the 70-90 age group who were of the same educational level. They played bridge (some of them since the age of 60) and it seemed to have practically an analgesic effect. For instance, a 90-year-old woman with severe spondylarthrosis took large quantities of analgesic drugs with little effect; when she played bridge, however, she had no pain. Among our aged subjects, bridge playing represents a real bridge to life. For them, to be
* Chief Surgeon of the Surgical Committee of the First Instance. ** Laboratory, Chief Physician. Address for correspondence: Zsuzsanna Denes, MD. Lab. Chief, Central Laboratory, Orszagos Orvosszakertoi Intezet, Budapest VIII. Mezo Imre UT 19/A, Hungary. t National Director General: Dr. Gabor Borsanyi. 137
HUTTERER AND DENES
Vol. XXIII
present at a game of cards gives a feeling of importance because, if one of them should be absent, it would be impossible to make up a party. The "conscience of bridge" drives them to be present whether it rains or snows. Even if they have a family, they feel cosier with their fellow card players because they are of the same age and their memories of the past are identical. The harmony among bridge players is surprising. The news that one of them is ill spreads fast among the partners, and they hasten to give every assistance to the person in trouble. Bridge playing is also appropriate for people who are hard of hearing. It is enough to understand the bidding, and in this respect the partners are tolerant. According to our observations in this study, bridge playing is an excellent occupation for maintaining good psychic health in the aged (4,
During active exercise the muscular system exerts a pumping action which sends the blood toward the heart. At the same time the carbon dioxide and lactic acid which develop during muscular action shift the muscular pH toward acidity. This results in vascular dilatation. In senescence, rapid deterioration and slowed anabolism result in atrophy. Regular exercise delays atrophy and degeneration, and aids in the regeneration of injured tissues. Thus, for the aged, it acts as a remedy. "Dosage. " If exercise acts as a remedy, then it should be administered in individual dosage schedules. Moreover, just as improvement may follow appropriate dosage, so may harm follow a dosage that is too high. Overdosage means overstrain, which may activate disease (e.g., cardiac decompensation) in the elderly.
5).
Physical exercise for the partially disabled elderly
The role of gymnastics Plato observed the interdependence of soul and body. Man is imperfect if he cares only for his soul and allows his body to be torpid. One of the forms of body culture is gymnastics, for the maintenance and development of the intrinsic values of the human body. Even infants need gymnastics (6). Rhythmic physical exercise performed in a cheerful mood is also desirable in senescence. It has special significance during the presenium for prevention of the atrophy and articular restriction so characteristic of old age. Physical exercise improves blood circulation and reduces the tendency toward obesity. This form of preparation for old age lessens the impact of senescence. Gymnastic exercise for a few minutes daily is valuable therapy in all periods of life. It not only improves the physical condition by enhancing mobility and physical appearance, but helps the subject to endure mental stress and to combat disease. One aim of physical exercise is to mobilize restricted joints. Limbering-up exercise helps the patient to meet the motion requirements of everyday life. Physical exercise is the functional stimulus of the organs of locomotion. It increases intermediary and respiratory metabolism, enhances blood circulation and intestinal activity, prevents maldistribution of fat, and increases mobility of the joints. Its general effect is physical and mental refreshment.
138
We have observed the effect of physical exercise in 338 patients over the age of 50. The age distribution was as follows: 231 subjects in the 51-60 age group, 70 in the 61-70 group, 34 in the 71-80 group, and 3 in the 81 + group. There were 239 females and 99 males. Their locomotory disabilities included spondylosis, polyarteritis, polyarthrosis, periarteritis humeroscapularis, osteoporosis, post-traumatic conditions, and pes planus. Physical exercise had a favorable effect in every case, on both the local and the general condition. The patients were pleased with the slightest improvement and they felt extremely well. As movement became easier, they were less in need of assistance and thus they became more self-confident-a significant factor in the life of the aged doomed to passivity. Physical exercise reduces contractures and thus, pain. Old patients are often surprised to note that a previously rigid shoulder or ankle joint can be moved. They are better able to take care of themselves and acquire a feeling of security and self-assurance; as a consequence, depression disappears. The favorable psychic effect of improved mobility is unquestionable. Even though complete recovery from limitation of motion cannot always be achieved, the aged person is happy with a degree of improvement that enables him to carry. out the activities of daily living. The following is an example: A 67-year-old woman had periarteritis humero-scapularis. For six months her right
March 1975
PSYCHOSOMATIC REHABILITATION OF ELDERLY PERSONS
shoulder had been virtually immobile. She could not dress or comb her hair, and could eat only with difficulty. She was depressed, partly because of the pain and partly because of her inability to provide for herself. In addition, she could not care for her grandchild. Previously she had managed the cooking and housework, but now these activities were impossible. With appropriate shoulder and general exercises, the shoulder contracture gradually improved, as did her mood and general condition. As she was able to resume her former activities, her self-assurance and peace of mind returned. It is never too late to start physical exercise and there are virtually no contraindications to moderate amounts, individually determined. Certain forms of exercise (e.g., respiratory) may be employed even in seriously ill bed-
ridden patients. The results are always beneficial, and this encourages the patient to continue with the program.
Acknowledgments We wish to thank Dr. Gabor Borsanyi, National Director-General, for supporting our study, and Mrs. I. Palese, technical co-worker, for valuable assistance. REFERENCES 1. Denes Zs: Z Alternsforsch 21: 367, 1969. 2. Denes Zs: Z Alternsforsch 26: 67, 1972. 3. Szarvas A: Contribution at the Scientific Session of the Hungarian Society of Gerontology, Budapest, May 7, 1974. 4. Denes Zs: Rev Espan Gerontol 2: 155,1973. 5. Lang T: Magy Nemz, January 5, 1974, p. 7. 6. Sasdi Wiesenberg W: A Jlitekos Torna. Playful Gimnastics. Budapest, Edition Medicina, 1972.
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