Alfonso, Eugenio, M.D.
Aging and longetivity
by Eugenio Alfonso, M.D.
- page 47-59
The Rotary Balita no. 784 (November 10, 1955)
(In the following speech delivered by community service chairman Gene Alonso in the last meeting of the club he says: Somehow, we may be able to give the aged a sense of security, a feeling of being wanted, help in maintaining their self-respect, along with material blessings they so richly deserve.)
Hitherto, the Community Service of the Rotary had always emphasized service to youth so much so that this form of service had monopolized nearly all its time, attention, and activities.
Today we will put aside just for a while, considerations on service to youth and will dedicate our efforts to the discussion on the problems of the golden years of life, or the problems of the aged.
I choose the subject "Aging and Longevity" because of the many socio-economic implications arising from the increasing incidence of the aged people in world wide population groups in recent years.
It is a biblical saying that the days of man's years are three score years and ten, yet millions have lived well beyond this figure today. Book of Genesis, however, records that God stated of man: "His days shall be a hundred and twenty years." Biologists find support to the theory that man's natural life span is actually 150 years, based on the fact that most animals live about six times longer than it takes them to grow to full physical maturity. Human growth does not stop until the age of 25; and if man were consistent with his biological relatives in this respect, man should live to be about 150.
We have heard and read stories of men reaching over hundred years, but historical records are either inaccurate or unavailable. But the case of Christian Drakenberg of Denmark is a different one. This is the guy who lived up to the age of 146 and who almost reached the theoretical ideal. He was born in 1626, according to reliable records. He was a merchant by profession, fought three wars against Sweden and was held in slavery for 15 y years. At 111, he married a widow of 60. At 130, as a widower, he was courting several women but none had accepted him and he died disillusioned.
Another reported authentic case of unusual longevity is that of Thomas Parr. Born in 1485 in the reign of King Edward IV, he died after he had outlived nine princes, in the tenth year of the tenth of them, at the age of 152 years and 9 months. The immediate cause of his death was attributed to a change of food and air and habits of life as he was brought from Shropshire to London, "where he fed high and drunk plentifully of the best wines."
THE AGING PROBLEM-"One might as well be dead as be old" expresses an almost universal attitude toward aging. Aging is a socio-economic problem in practically all countries of the world. Reduced earning power, waning health, and lessened interest in life, and the certain knowledge that the rest of life is not worth living, keep many people from being revered members of society. It is for these multiple reasons that too frequently the death of an aged relative is desired, as perhaps he may become a real burden and a liability; or if he happens to be rich, the heirs want to get and enjoy their inheritance earlier.
Nations and countries vary in their attitude toward the aged. Take for example China where the aged are the patriarchs of the family. Their word is law. They are honored and respected. This is one reason, if not an important one, why we find more old people in China than anywhere else in, the world. It is, however, different with the Indians and Eskimos. When they move to greener fields, the aged are provided with a piece of jerked meat and left to starve and die. Sweden is very humanitarian because the government provides the aged with a home in a compound and gives them a monthly subsidy. In our country, we have charitable and relief agencies under the Department of Health and Public Welfare and the Social Welfare Administration. Yet nothing definite has been planned in the care of the aged. Right in our City of Cebu, we find the sidewalks cluttered with old, sickly, undernourished, crippled beggars asking for alms, or we see them lying down on the pavements as if waiting for life to end. Here is where the Rotary clubs all over the Philippines can come in to help those who have reached the golden years, to make it possible for them to lead happy, healthy and reasonably productive lives. Somehow, we may be able to give the aged, a sense of security, a feeling of being wanted, help in maintaining their self-respect, along with material blessings they so richly deserve.
WHAT IS THE PRESENT PROBLEM? The present problem today with reference to population is worst than the atomic bomb. The world population is fast growing and along with this is the ever-increasing old-age population. According to Dr. Huxley, the British Biologist who visited Manila last August, the world population is increasing at the rate of 34,000,000 a year. Serious thoughts and studies should be given to this problem of senescence due to the fact that the population structure of civilized nations is hanging to ward increasing proportion of the elderly. Two thousand years ago the average length of life was 25 years. A man of 45 today has 70 chances in 100 of reaching the age of 65. Although there is no definite statistics today in our country, yet it is an admitted fact that there are gains in longevity. America has more accurate data. In the dawn of the 20th century, the average life expectancy is 65 years. If the knowledge of medical science could be completely utilized, it would be possible to increase life expectancy to 75. In the last fifty years, the number of people over 65 has been increasing twice as fast as the general rate of population. The big question now is, "What happens to the economy when a large portion of the population is forced into idleness at the customary age of 65?
We do not know as yet how important the elderly will be in our national culture and economy, because they have never had a chance to demonstrate what they can do. If, however, these groups of elders are disabled by reason of chronic and progressive invaliding diseases, then they will cause naturally a serious drain upon our resources; but if, on the other hand, they are well and vigorous, they become indescribably valuable in the development of a more mature culture. It is therefore our concern now to give practical health education and practical health program for enabling these men and women to use and enjoy the added years of life. Indeed this is a challenge not only to the medical profession alone, nor to the Rotarians, but to everybody.
In Los Angeles alone today, 100,000 aged attend special courses on how to put zest in their lives and how to prepare for retirement. They study everything from Bach to Baby-sitting; from Samba to Semantics. The subject, "Retirement-Your Second Career" is attracting thousands of the aged in New York.
Speaking of age as a liability, I like to ponder on what the world owes to many old people. Let me mention here just a few for lack of time. We have the famous English philosopher, Thomas Hobbes, who wrote his translation of the ODYSSEY at 87 and of the ILIAD at 88; Tennyson wrote the famous CROSSING THE BAR at 83; Oliver Wendell Holmes found his memory, his energy and his intellect improved in his 80's. Sir Winston Churchill, still living, proves that years only add to one's usefulness and joy of living, Still we have another example, Dr. A. D. Carlson, emeritus professor, University of Chicago, President of National Medical Research and now considered the best gerontical example at 80, who still spends a 9-hour day on the problems of aging, still hale and hearty. These are but a few examples of many old people all over the world who have achieved great things in their old age.
I am relating these instances to illustrate that there can be life to years. It is faith in something -enthusiasm, desire and love of living-that makes our declining years worthwhile.
Culture, which is the composite judgment and sense of values of a race or nation, matures along with the population from which it is derived. Therefore, a healthier, happier, wiser and more tolerant maturing mankind may give to the world a lasting peace.
What is the Difference Between Chronologic and Biologic Age?-When one is asked for his age he gives a number in terms of calendar figures. This is called the chronologic age. Whereas chronologic age is fixed by the calendar, biologic age is the true age determined by heredity, the state of health, and functioning capacity. Chronologic and biologic ages do not necessarily run concurrently. Many persons show senescent changes prematurely, while others grow old slowly. Dr. Cramton of New York tells us that a 60-year old man may have a 40-year old heart, 50-year old kidneys and 80-year old liver.
So it seems, therefore, unfair to have the doctrine of compulsory retirement arbitrarily fixed at 65. It would be fairer if this is made elastic, according to the biological age of the individual. Take again, for example, the case of Dr. Carlson, head of the Physiology Department of Stanford University of California. On reaching his 65th birthday he was forced by the University's rule to retire. Examining the "evidence" he is a Swede he concluded that this was absurd. His mind was clear, and his health good. He admitted that chronologically he had entered the "old age" but what did that term mean? In spite of his retirement age, he remained as professor emeritus for 15 years. Therefore in fairness to the aged who are biologically in good shape, we are seeking a scientific criterion as a substitute for chronological age as the bases for job seeking. retirement, and for other purposes.
WHAT ARE THE COMMON DISEASES OF OLD AGE?-Diseases can occur at any phase of life span. Do not believe that cancer can occur only in the middle and old age, because it also is frequently found in children and the young. There exists, however, a group of diseases which commonly affect persons after the peak of maturity is reached. The common ones are: cancer, cerebral hemorrhage, heart diseases and nephritis. In the same category are diabetes and arteriosclerosis. We call these diseases of middle life and old age.
The Introduction of Gerontology and Geriatrics -From time immemorial, man's dream is to have life and vigor forever. Can this dream possibly come true? If man has conquered infectious diseases, built space satellites and harnessed the atom, there is yet the possibility that someday he may be able to arrest, if not greatly slow down, the process of aging.
With the increasing old age population, Gerontology was born. Gerontology is the newest specialized field of medical science concerned with the phenomena of aging and ways of retarding them. Its companion science of Geriatrics is the medical treatment of diseases and affections of old age. Perhaps the greatest handicap to geriatric medicine today is the lack of knowledge concerning the complex causation of chronic and progressive diseases so common and so disabling to senescence. Understanding of cause is prerequisite to effective treatment.
Is death from "Natural Causes" inevitable? No authority can say explicitly that it is. But there are some evidences that it is not. Take for example the world famous experiment of Dr. Alexis Carrel. In his experiment, he kept a bit of chicken embryo alive in a nutrient fluid from which metabolic wastes were regularly removed for 36 years. He ended the experiment because it seemed obvious that the tissue could survive "forever." Another example is the giant sequoia trees of the United States which keep on growing and living perpetually until storm or disease or some environmental disaster kills them. So, there are certain forms of life which may live "forever" in nature, and death is not exactly inevitable.
What is aging and what causes it?-Up to the present the gerontologist cannot define definitely what is aging or what causes it. Aging as we know it, is a change; a continuous and insidious process. An integral part of all living, aging begins with conception and ends only with death. Even in embryonic life the fastest stage of human growth, atrophy takes place. Conversely, even in advanced senescence the hair continues to grow. A replacement type of growth continues until the end of life.
An individual may be considered "aged" or "elderly" when his physical activity and vigor begin to decline substantially. This decline generally begins in the sixties, but in some it may start at 40; in others it may be postponed to the age of 70 or more. This is the period during which the cumulative effects of tissue damage and aging become evident.
That most of the centenarians were men confirms earlier observations of an apparent sex difference, although there are more women than men between the ages of 70 and 90, many more men than women reach 100.
What are the Senescene Changes? In senescence, involutional changes by time alone are complicated by the effects of accumulative use, abuse, misuse, and multiple and variable injuries. Thus aging leads to increasing divergence and individual variations. Some are obvious and others are obscure. Many people who were approaching or had passed the century mark seemed no older than the average person in his seventies. Certain changes in appearance however were typical.
Within this span of senescence changes, there is a sequence of events which add up to the physiological "rusting out" of individual changes in the eyes are first significant. Statistics reveals that after a person leaves his teens, the eyes begin to slow down greatly. At 30, 30% have visual shortcomings; at 40, 40% have faulty vision, From then on eyesight parts rapidly. At 50, 71% have errors in vision and at 60 years 82%. Acuteness of taste begins to decline at 50, smell at 60. Hearing begins to fail at 20 when there is a gradual loss of ability to hear high tones.
Past the age of 25 or 30, man finds himself becoming less elastic. Bones become brittle due to demineralization. The spinal column begins to bow outward and people lose about 2 inch in height for every 20 years of adult life. Skin changes, which come with aging, include increased pigmentation of exposed parts, dryness due to decrease sebaceous glands secretion. Heredity, disease, diet all play a part in falling of hair, However, there is increase in the growth of hair of eyebrows in the nose and external ears. At 20, digestive juices and acidity begin to decrease. At 30, the essential enzymes (digestive juice) fall off steeply, This explains the all too familiar increase in digestive troubles at middle and advanced age.
Normal mental changes which accompany aging include fixation of ideas, a little slowing of the mental pick-up and failing memory, especially for recent events. At 22, man reaches his peak in rate and speed of learning, show decline after and accelerated somewhat at the age of 40, until by the age of 80, the ability to learn has retrogressed. Learning ability in the aging is largely dependent upon the desire to learn and interest in the subject being learned. Analytical judgment begins to decline not before 55 at the earliest and perhaps not before 65 at the latest.
What he cannot escape noticing, and which makes him begin to "feel old," is his decline in physical strength and vigor due to neurological decay. Muscles undergo shrinkage due to loss of water and result in fibrosis,
In the Endocrine System-We have here interesting facts. The reproductive organs of the female begin to age with the onset of menstruation and the whole apparatus is "worn" out somewhere between 40 and 45. This is manifested by the so-called menopause. In men, the life span of the testes is longer. The production of sperm begins a little later and last longer. Hormone mechanism of the testes which is involved in libido and copulation appears to fail earlier than spermatozoa production. Sperm production begins to decline slightly at 25 and male fertility ordinarily fails at about 65, although production of immature sperm may continue for many years thereafter. (See Kinsey report on the differences in ages of the libido between the sexes).
Another endocrine gland is the pancreas. This tend to slow the production of insulin and diabetes tends to rise with age, at least up to 50 or 60.
The heart degenerates with aging but this process is not by itself usually fatal. It is in the blood vessel where greater trouble lie-we have high blood pressure and hardening of arteries called arteriosclerosis which both tend to increase with aging. If a blood vessel ruptures in the brain we have the so-called "stroke" which may kill or result in paralysis.
What is the Task Before Us?-It is to create health and life value to correspond with the duration of life. Life is multi-dimensional. To be full and rich it must have depth and breadth as well as length. The object of geriatric medicine is to add breadth and depth rather than mere length of life.
The question now before us is, "Is there a cure for aging?" Why do some people stay young and longer than others? The "Fountain of Eternal Youth" is still to be discovered. Ponce de Leon died finding the fountain of youth. Let us review what has been done by scientists in the last few years. In 1930, a Russian scientist, Dr. Alexander Bogomelets, claimed rejuvenation with his ACS serum derived from the human spleen and bone marrow (from the corpses naturally.) This scientist declared that man should have no trouble living to 150. For his supposed brilliant work, he received the Order of Lenin, and many other honors. Nothing has been done to prove the claim until after the world war when American scientists began to prove it in their laboratories. Conclusion: They found the claim to be a complete illusion and utterly useless.
Voronoff, another Russian, in 1920 and 30's claimed rejuvenation by transplanting sex glands of chimpanzees to human beings. He made quite a fortune of this, but the claim was a false one.
Dr. Eugen Steinach, an Austrian, claimed that tying and cutting the spermatic cord would rejuvenate man. The theory behind it is that more hormones will be poured into the system and thus increase sexual vigor and general energy. There is no truth about rejuvenation in this method, and although it apparently stimulates sexual power, at the same time it sterilizes the male. Recent studies prove that male and female hormones have their good uses in various disorders but not as rejuvenators.
Promising Medical Theory. What is then the "secret" to gain a happy old age? A favorable heredity and freedom from illness during the early years appear to be the two factors of importance. The most recent theory is the use of hormones. It is said that the best prospect for medical prevention and probably for cure in a limited sense lie in the pituitary hormone and that of the adrenals. It is with great hopes that this will bring someday the solution of the problems we have today.
It is worth mentioning here that Gerontologists meanwhile agree with Oliver Wendel Holmes that "One of the best ways to insure a long life is to make a careful selection of grandparents." This means that many weaknesses leading to premature aging or death are inheritable. Long-lived people tend to have long-lived children. Hereditary constitution is undoubtedly a factor in determining the life span of an individual.
Environment in its broadest sense (everything we do or is done to us and to the internal body's cells) is a factor we have to worry about to get long life.
In accordance with latest geriatrics studies, we give you the following basic guidance in advancing years in order to create health and life value corresponding to the duration of life:
1. Periodic Health Examination The truth about the matter is that this health examination should begin from the cradle and end in the grave. But since the years from 40 to 60 are the ones where degenerative diseases usually start, it is imperative that persons in that bracket should undergo an annual medical check up. The idea behind health guidance for geriatric patient is the advisability of attempting to construct greater health in the apparently well individual who, though not ill, is by no means at optimal level of vitality. The periodic health examination and health consultation should cover present defects, present physical hygiene and predictable future problems. The best result can be expected if the above criteria are fulfilled. The patient must take the initiative, of course, in seeking guidance, cooperate fully in diagnostic studies and accurately carry out the advices he receives.
2. Diet-Nutritionally adequate diet enough to prevent starvation is prescribed. At present the best diet in aging is one higher in protein (meat, etc.), moderate in carbohydrates and less in fats. Begin early self-control in amounts of fats taken. Arteriosclerosis is the result of the body's inability to handle fats. Milk and leafy vegetables are important for adults as well as for children. Vitamin contents must be higher than average and must be supplemented if necessary. It has been proven by experiments in laboratory animals that fasting is a factor in prolonging life.
Overeating with resulting over-weight increases mortality at the rate of 1% for each pound over normal weight. Weight reduction when necessary should be encouraged. Up to 40 being under-weight is apt to increase mortality, too, but beyond that age it is a distinct. advantage. Prevention of obesity is a must in geriatrics.
3. Work and Play should be balanced. When work is enjoyable and constructive, it usually provides relaxation. The best insurance for a healthy and satisfying old age, according to Dr. Carlson, is never to stop learning and never to stop working. Like the muscles, the mind can fail from disuse. As for working, it is physically and mentally therapeutic. The kind of work does not matter so long as it is useful something that the individual can take satisfaction with and pride in.
4. Alcoholic Drinks-Dr. Carlson now at 80 still drinks, but in moderation. He says for aging, cocktail is a good stimulant, two is a "waste and three is a poison."
5. Exercise-Moderate calisthenics and walking are considered the best forms. As I previously said these are the basic guidance, and for further detailed information, please see your family physician.
Stiglets points out: "We are entering upon an age of age. Let us make the best of it. If further aging comes to mean continued growth, we will succeed in enriching life immeasurably. If aging is permitted to mean arrest of progress and stag. nation, the second 40 years means rusting and rotting." Life is a change and one of the changes is that of aging. There is youth in old age and beauty, too if we have but the eyes to see them, and there is peacefulness that stems from ripe maturity if we have but the inner resources to appreciate.
Perhaps the most important message which we physicians can convey to maturing people is that health is not a right but a privilege and thereby entails the obligation and exertion to maintain it. Medical science cannot give health to anyone. It merely can guide, so that people may learn how to use, but not abuse, their endowment.
—From: SUGBUANON