Louis
10-04-2006, 10:56 PM
NYT Article on aging. Original is here (http://www.nytimes.com/2006/10/05/health/05age.html?pagewanted=1&ei=5094&en=b4e145b450318949&hp&ex=1160020800&partner=homepage)
October 5, 2006
The New Age
Old but Not Frail: A Matter of Heart and Head
By GINA KOLATA
Mary Wittenberg, the 44-year-old president of New York Road Runners, is a fast, strong and experienced runner. But she races best, she says, when she runs just behind Witold Bialokur. He can run 10 kilometers, or 6.2 miles, in less than 44 minutes and he is so smooth and controlled.
“He’s like a metronome with his pacing,” Ms. Wittenberg says. “I am often struggling to keep up with him and it’s a good day when I do.”
While Mr. Bialokur’s performance would be the envy of most young men, he is not young. Mr. Bialokur is 71.
It is one of the persistent mysteries of aging, researchers say. Why would one person, like Mr. Bialokur, remain so hale and hearty while another, who had seemed just as healthy, start to weaken and slow down, sometimes as early as his 70’s?
That, says Tamara Harris, who is chief of the geriatric epidemiology section at the National Institute on Aging, is a central issue that is only now being systematically addressed. The question is why some age well and others do not, often heading along a path that ends up in a medical condition known as frailty.
Frailty, Dr. Harris explains, involves exhaustion, weakness, weight loss and a loss of muscle mass and strength. It is, she says, a grim prognosis whose causes were little understood.
“It means that some people spend a long time in a period of their life where they have lost function,” Dr. Harris says. “People find that very distressing, and there is a tremendous health care cost.”
Now, though, scientists are surprised to find that, in many cases, a single factor — undetected cardiovascular disease — is often a major reason people become frail. They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace.
Investigators say that there is a ray of hope in the finding — if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition.
A second finding is just as surprising to skeptical scientists because it seemed to many like a wrongheaded cliché — you’re only as old as you think you are. Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path.
Still, it is a view that can lead to blaming the victim, and some scientists at first resisted it. Now, though, more and more say they have been won over by an accumulating body of evidence.
“I am changing my initially skeptical view,” says Richard Suzman, who is director of the office of behavioral and social research programs at the National Institute on Aging. “There is growing evidence that these subjective experiences might be more important than we thought.”
The Walking Test
Eleanor Simonsick’s initiation into the unrecognized debilitations of aging came with a research study she helped set up. The question was whether older people who are relatively vigorous are also longer-lived. As an epidemiologist at the National Institute on Aging, she thought it was time to ask that in a rigorous way.
So she and her colleagues recruited 3,075 apparently healthy people in their 70’s who said they could walk a quarter of a mile with no trouble and climb a flight of stairs. Each was asked to walk up and down a corridor 10 times, for a distance of a quarter mile, maintaining their pace and not stopping to rest.
A quarter of them could not do it. And it was not just a matter of age. The average age of those who could do it was 73. So was the average age of those who could not. Dr. Harris explained: “I believe most people can amble. But we were asking them to walk as quickly as they could without stopping. That’s what people couldn’t do.”
Some walked so slowly, with tiny steps and labored cadences, that the researchers told them that they could stop because it was clear that they could never finish. Others Dr. Simonsick added, “just said: ‘I’m done. I’m sitting down.’ ”
“It’s very sad,” she added. “It’s not like we put them on a treadmill and cranked it up. You get the sense that they are simply deconditioned.”
The problem became worse. “In the first two years, a third of the group that could walk the quarter mile said they were beginning to have difficulty,” Dr. Harris said. “We thought, ‘Oh, this is impossible.’ ”
But it was real.
The researchers published their data in the May 3 issue of The Journal of the American Medical Association, finding that being unable to walk a quarter mile within five minutes portended troubles. For each minute beyond five, the risk of dying in the next four years increased by a third, the risk of having a heart attack increased by 20 percent, and the risk of having a disability increased by half.
Those who took more than six minutes for the quarter-mile walk had the same risk of dying or having a heart attack as those who could not walk the distance at all, and the effect was independent of age.
That led to the next question. Could teaching people to walk farther and faster prevent their growing so weak they could hardly walk?
Dr. Jack Guralnik, acting chief of the laboratory of epidemiology, demography and biometry at the National Institute on Aging, hopes it can. A new pilot study that he helped direct found that, with training, people could walk faster, improve their balance and more easily rise from a chair. Now he wants to expand that study to explore whether such training helps people retain their ability to walk and improves their health.
Richard J. Hodes, director of the National Institute on Aging is intrigued.
“It would be an extremely expensive study,” Dr. Hodes said, adding that its costs have not been added up. But, he said, if training could keep just 10 percent to 20 percent more people mobile, “I’m sure billions would be saved.”
Staving Off Frailty
Dorothy Bower, 78, used to take walks around the grounds of her assisted living residence in Wilkinsburg, Pa., near Pittsburgh. But no more. In the past six months, Ms. Bower says she has lost her energy. “I make it down the hall and to the dining room,” she says. “I have the feeling that if I worked at it I would get better, but it’s hard to get the motivation to try harder.”
“It is enough of an effort as far as I’m concerned to get to the door of our room,” Mrs. Bower says. “That takes me about five minutes.”
Mrs. Bower’s problem is frailty, doctors say. It is increasingly common as people age, and its symptoms — losing muscle mass and strength, feeling depleted, walking slowly, losing weight and doing less and less in a day — go together, says Dr. Linda Fried, a geriatrician and epidemiologist at Johns Hopkins who defined and characterized the syndrome. “They are all connected and form a vicious cycle,” she says.
Gerontologists say the full frailty syndrome is uncommon until people reach their 80’s, but its likelihood increases rapidly from then on.
(continued)
October 5, 2006
The New Age
Old but Not Frail: A Matter of Heart and Head
By GINA KOLATA
Mary Wittenberg, the 44-year-old president of New York Road Runners, is a fast, strong and experienced runner. But she races best, she says, when she runs just behind Witold Bialokur. He can run 10 kilometers, or 6.2 miles, in less than 44 minutes and he is so smooth and controlled.
“He’s like a metronome with his pacing,” Ms. Wittenberg says. “I am often struggling to keep up with him and it’s a good day when I do.”
While Mr. Bialokur’s performance would be the envy of most young men, he is not young. Mr. Bialokur is 71.
It is one of the persistent mysteries of aging, researchers say. Why would one person, like Mr. Bialokur, remain so hale and hearty while another, who had seemed just as healthy, start to weaken and slow down, sometimes as early as his 70’s?
That, says Tamara Harris, who is chief of the geriatric epidemiology section at the National Institute on Aging, is a central issue that is only now being systematically addressed. The question is why some age well and others do not, often heading along a path that ends up in a medical condition known as frailty.
Frailty, Dr. Harris explains, involves exhaustion, weakness, weight loss and a loss of muscle mass and strength. It is, she says, a grim prognosis whose causes were little understood.
“It means that some people spend a long time in a period of their life where they have lost function,” Dr. Harris says. “People find that very distressing, and there is a tremendous health care cost.”
Now, though, scientists are surprised to find that, in many cases, a single factor — undetected cardiovascular disease — is often a major reason people become frail. They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace.
Investigators say that there is a ray of hope in the finding — if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition.
A second finding is just as surprising to skeptical scientists because it seemed to many like a wrongheaded cliché — you’re only as old as you think you are. Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path.
Still, it is a view that can lead to blaming the victim, and some scientists at first resisted it. Now, though, more and more say they have been won over by an accumulating body of evidence.
“I am changing my initially skeptical view,” says Richard Suzman, who is director of the office of behavioral and social research programs at the National Institute on Aging. “There is growing evidence that these subjective experiences might be more important than we thought.”
The Walking Test
Eleanor Simonsick’s initiation into the unrecognized debilitations of aging came with a research study she helped set up. The question was whether older people who are relatively vigorous are also longer-lived. As an epidemiologist at the National Institute on Aging, she thought it was time to ask that in a rigorous way.
So she and her colleagues recruited 3,075 apparently healthy people in their 70’s who said they could walk a quarter of a mile with no trouble and climb a flight of stairs. Each was asked to walk up and down a corridor 10 times, for a distance of a quarter mile, maintaining their pace and not stopping to rest.
A quarter of them could not do it. And it was not just a matter of age. The average age of those who could do it was 73. So was the average age of those who could not. Dr. Harris explained: “I believe most people can amble. But we were asking them to walk as quickly as they could without stopping. That’s what people couldn’t do.”
Some walked so slowly, with tiny steps and labored cadences, that the researchers told them that they could stop because it was clear that they could never finish. Others Dr. Simonsick added, “just said: ‘I’m done. I’m sitting down.’ ”
“It’s very sad,” she added. “It’s not like we put them on a treadmill and cranked it up. You get the sense that they are simply deconditioned.”
The problem became worse. “In the first two years, a third of the group that could walk the quarter mile said they were beginning to have difficulty,” Dr. Harris said. “We thought, ‘Oh, this is impossible.’ ”
But it was real.
The researchers published their data in the May 3 issue of The Journal of the American Medical Association, finding that being unable to walk a quarter mile within five minutes portended troubles. For each minute beyond five, the risk of dying in the next four years increased by a third, the risk of having a heart attack increased by 20 percent, and the risk of having a disability increased by half.
Those who took more than six minutes for the quarter-mile walk had the same risk of dying or having a heart attack as those who could not walk the distance at all, and the effect was independent of age.
That led to the next question. Could teaching people to walk farther and faster prevent their growing so weak they could hardly walk?
Dr. Jack Guralnik, acting chief of the laboratory of epidemiology, demography and biometry at the National Institute on Aging, hopes it can. A new pilot study that he helped direct found that, with training, people could walk faster, improve their balance and more easily rise from a chair. Now he wants to expand that study to explore whether such training helps people retain their ability to walk and improves their health.
Richard J. Hodes, director of the National Institute on Aging is intrigued.
“It would be an extremely expensive study,” Dr. Hodes said, adding that its costs have not been added up. But, he said, if training could keep just 10 percent to 20 percent more people mobile, “I’m sure billions would be saved.”
Staving Off Frailty
Dorothy Bower, 78, used to take walks around the grounds of her assisted living residence in Wilkinsburg, Pa., near Pittsburgh. But no more. In the past six months, Ms. Bower says she has lost her energy. “I make it down the hall and to the dining room,” she says. “I have the feeling that if I worked at it I would get better, but it’s hard to get the motivation to try harder.”
“It is enough of an effort as far as I’m concerned to get to the door of our room,” Mrs. Bower says. “That takes me about five minutes.”
Mrs. Bower’s problem is frailty, doctors say. It is increasingly common as people age, and its symptoms — losing muscle mass and strength, feeling depleted, walking slowly, losing weight and doing less and less in a day — go together, says Dr. Linda Fried, a geriatrician and epidemiologist at Johns Hopkins who defined and characterized the syndrome. “They are all connected and form a vicious cycle,” she says.
Gerontologists say the full frailty syndrome is uncommon until people reach their 80’s, but its likelihood increases rapidly from then on.
(continued)