“How incessant and great,” C.S. Lewis mused, “Are the ills with which a prolonged old age is replete.” It is hard to argue otherwise. Physical and mental decline, as well as the threat of the inevitable, can make seniority a trial.
As scientific progress and economic growth have allowed us to live longer, and as the birth rates have fallen in our societies, old age has begun to vex more people than those who are experiencing it. Britain is “woefully under-prepared” to cope with increasing numbers of elderly people, a House of Lords inquiry has found, and people must work for longer and in many cases live with fewer benefits and services.
Much of this is true but I have been maintaining that amid fears of the “grey Tsunami” leading to spiralling health and social care costs people have been overlooking means of helping older people to avoid the ill health and frailty that necessitates it. I am not the only one. At the turn of the millenium Professor Marian McDurdo observed that arguments concerning the provision of care for the elderly had “dominated discussion to the virtual exclusion of a search for strategies which might improve their overall health”. A decade later, Tom Kirkwood, director Newcastle’s Institute for Ageing and Health, lamented the fact that politicians and commentators still view an ageing population through a “prism of increased…costs” and called for an “expansion of scientific knowledge about ageing”.
Forget the social costs of ageing for a moment. Yes, they are important, but it should not be forgotten that we are discussing real people who will be forced to endure the worst aspects of the conditions that will require treatment. There is sarcopenia: the degeneration of lean body mass that weakens people, making tasks as simple as carrying bags or rising from a chair difficult; worsens balance, raising the threat of falls and decreases metabolic rates, ensuring that people are intolerant of temperatures and at risk from obesity.
There is osteoporosis, in which one’s bone density is greatly reduced, exacerbating the risk of fractures. Older people are more liable to fall than others, then, but are also more likely to do themselves severe harm once they have fallen. Fractures can also occur without obvious provocations. Bones in the spine collapse, making it hard for sufferers to hold up own body weight. The slightest jolt – as little as a cough or sneeze – can lead to fractures of the ribs.
Then there is the possibility of cognitive decline. Dementia and Alzheimer’s confuse, annoy and sadden their victims and those around them. More than any one disorder, though, there is the pain associated with losing one’s independence: the potential for frustration in one’s ability to realise ambitions and embarrassment in relying on others to fulfil tasks.
Decline and/or death will come to all of us at some point and genetics, ill-advised decisions and misfortune will bring either or both of them on sooner rather than later for many. There are, however, steps that can be taken, in preparation for and during old age, to help millions avoid or ameliorate the consequences of these and other afflictions. Some may be complicated chemical treatments, of which I am ignorant enough that I cannot discuss them, but other known or apparent health-promoting measures are uncomplicated and accessible and deserve to be popularised so that today and tomorrow’s old people can profit from them.
1. Resistance training – Few old people are going to become bodybuilders like the Herculean nonagenarian Charles Eugster but extensive evidence suggests that resistance training improves one’s health to such an extent that it should not be seen as the preserve of musclehead. Research has shown that pensioners up to the age of 96 can make impressive gains in strength and muscle size with the judicious use of resistance training. It builds muscles around bones, which stimulates the reinforcement of their density and makes one less vulnerable to osteoporosis. A review published by the Human Nutrition Research Center on Aging found two-dozen studies that illustrated this effect. Other studies have shown evidence that resistance training lessons the risk of diabetes in men, and even that it is an effective antidepressant among elders.
2. Leucine – “Leucine” sounds like a constipation remedy but it could actually be significant in helping one avoid the damage of sarcopenia. French scientists have found evidence that suggests that eating diets rich in this amino acid can help the elderly to process protein in a manner that enables them to preserve their muscles. Dr. Michael Rennie of the University of Nottingham Medical School said further research was needed to test the theory but that older people could still act upon its tentative recommendations. Leucine is abundant in plant and animal foods, and scientists have also found evidence that leucine supplements may be effective. (For ethical reasons, I would ask people to consider maximising plant sources. They are no less healthy and, indeed, can be more so.)
3. Goal-oriented sociability – There is no surefire way of avoiding Alzheimer’s disease, dementia and their effects but there are lifestyle choices that could improve one’s chances of evading and ameliorating them. Patricia Boyle and her colleagues at the Rush Alzheimer’s Disease Center found an association between living a purposeful life and a lesser threat of the deleterious effects of pathologic changes on cognition in patients with Alzheimer’s. Scientists at the Karolinska Institute, meanwhile, studied hundreds of older people over a matter of years and found that those who lived sociable lives, as long as they are also marked by low neuroticism, seemed to have a lesser risk of cognitive decline. Ideal activities, then, would increase one’s interactions with others, diminish stress and offer goals to be pursued: arts, sports, exercise, charitable, religious and even political collaborations. If you are a misanthrope, of course, this may be like removing tumours with bullets but I’m insisting that on seek these benefits.
4. Omega-3s and Omega-6s - “Fat” is not a meaty monolith. There are all kinds of fats, and they are more or less healthful. A study published in 2007 found that eating omega-3 fats, those found in fish, walnuts and flax, was associated with a lessened risk of cognitive impairment while the excessive consumption of omega-6 fats, those common to vegetable oils and some nuts and meats, seemed to increase the threat. To consume omega-3s is more important than avoiding omega-6s as eating the former makes up for one’s consumption of the latter but cutting down on soy, corn, canola and sunflower oils is a good idea anyway. They are rubbish.
5. Aerobic exercise – Exercise gets bloody hard for anyone as they grow old. I find it hard, for goodness sake, and I am twenty-two. As Dr. Jerome L. Fleg details in his essay “Aerobic Exercise in the Elderly”, however, it can be done. Healthy older people and even some men and women with clinical heart disease can improve their fitness and derive reductions in blood pressure and depression and improvements in lipid levels, glucose tolerance and bone density. A study last year also suggested that regular aerobic exercise improves brain power in the elderly. A lot of old people, as well as a lot of young people, may not be sure of how to exercise without risking spectacular accidents but this merely emphasises the need for these issues to addressed so that safe, effective means of obtaining their benefits.
6. Vegetables – This is almost as obvious as “don’t smoke” or “breathe” but it is so true that it deserves to be emphasised. The benefits of consuming vegetables are numerous. Age-related macular degeneration, for example, increases one’s risk of accidents and, well, makes life less fun. Green vegetables such as spinach, kale, turnip leaves and broccoli contain lutein and zeaxanthin, organic pigments known as carotenoids, which, consumed in large amounts, have been found to reduce the threat of age-related macular degeneration by as much as 43%. Systematic reviews, meanwhile, have found that an increased intake of vegetables is associated with a lower risk of dementia, slower rates of cognitive decline, lessened risks of osteoporosis and, of course, a reduced likelihood of becoming obese and developing related illnesses. They taste nice as well. That wasn’t just fascistic propaganda from our parents.
7. Meditation – Now, I am no Buddhist. In fact, I went to a meditation class on one occasion and had to leave because I was giggling. There is, however, hard as some of us find it to imagine rivers running down our sides and so on, evidence that mindfulness-based meditation reduces the stress and loneliness that are not just inherently unpleasant but exacerbate or provoke damaging conditions. There is evidence that this is true not just for healthy adults but patients enduring cancer and heart disease. One paper has even suggested that meditation may have a beneficial effect on the length of our telomeres, which are molecule sequences that protect the ends of our chromosomes. Scientists believe that telomere length is a biomarker of ageing. Is this right? To be honest, I don’t have a bleedin’ clue. But, hey, try it for yourself if you would like to see whether it works or not. It’s not worth getting stressed about.
8. True love – Okay, this one is not accessible in the slightest but the research on relationships and health is so interesting that I am throwing it in here. A paper from the Karolinska Institute offered evidence that suggests that people who are married or co-habiting in middle-life are less likely than single, separated or widowed people to endure cognitive impairment, which, given contemporary trends, is of relevance. The news is not all good for lovebirds, though. Hui Zheng and Patricia Thomas have offered research suggesting that as one’s health declines marriage can be dangerous. Husbands and wives, it seems, are unwilling to ‘fess up to health problems as they emerge. Unless, of course, they are mild headaches or passing colds in which case they will send each other bonkers going on about them.
None of this is to insist that one should not lie around in front of the TV, consume a diet of bacon and doughnuts and imagine that meditation is something exclusively practiced by Gandhi and Steven Seagal. As unexciting as it can be for some people to contemplate the prospect of a run or a plate of spinach, though, I would suggest that giving oneself a much better chance to live an old age in which one is not reliant on carers and pharmaceutical companies is impressive. If further research and education can allow people to live in a state of health and independence in old age it will be almost as much of an achievement as allowing them to live at all.