Sunday, 1 December 2013

Not a review but a few useful words.

My Challenge to Ageing,  Edition 3. Risteárd Mulcahy. Kindle, 2013. Price E7.9

My publication on Kindle deals with the normal changes which we can anticipate as we retire and face later years. My purpose was to report the physical, mental, psychological and social changes which have occurred to me during these last 25 years after my retirement, added to my earlier experience as a physician dealing with older patients. We should learn to adapt to the normal changes of ageing if we wish to lead a normal life and remain an active member of society as well as sharing the same confidence and contentment of our earlier years. We need to recognise these changes to avoid unnecessary medical intervention. There is clear evidence that nowadays there has been overmedicalisation of the elderly through the unnecessary use of drugs and medical interventions. The current age of retirement at 65 years is no longer relevant as older people take an increasingly active role in modern society

The purpose of this review is not to provide details of my publication in Kindle but to look at all the factors in our lives which contribute to longevity and to eliminate the decrepitude which is too often a feature in older persons. My review can best be described as a challenge to longevity and how most people can usefully and happily reach optimum longevity and avoid decrepitude and dependency before they pass to their reward

Life expectation at birth in Ireland in males and females was approximately the same at about 50 years at the end of the 19th century. Early in the 20th century life expectation began to increase gradually and without interruption. By 1945 the life expectancy had reached 60 in males and 61 in females.  This improvement during the first 45 years of the 20th century could be attributed to a big fall in infant mortality and to the successful control of most of the epidemic diseases in the 1920s and 1930s. From 1945 to the last census in 2006, there has been a continued and uninterrupted increase in life expectation among both sexes with males reaching 76.8%.years and females 81/6 years.

The small disparity between male and female life expectation in the mid 1930s continued up to 1950 when the disparity began to increase. By the census of 1980 this disparity had increased from about one to 5.7 years. My colleagues and I in our paper published by the American Journal of Public Health in 1970 studied the smoking habits and mortality data in 15 different countries and we were able to conclude that this disparity could be largely if not entirely attributed to cigarette smoking.

The cigarette habit had increased dramatically after the last Great War, thanks to the influence of the Americans and British who were generous in supplying cigarettes to the troops. Subsequently this led to widespread advertising by the industry.  Smoking was largely confined to men and we predicted that the disparity would eventually fall to a more equal level when the cigarette smoking habit was substantially reduced or terminated. This fall is now evident from the 2006 census where the disparity is now reduced to 4.8 years. This trend will continue and may be reduced to one year or less as smoking is on the wane among middle and older people who are so vulnerable to inhaled tobacco.

Nevertheless, despite a male predominance of smoking there was still a slow increase in life expectation from 1950 to 2006 among men of 12.3 years and 14.5 years in women. The rise in life expectation continued up to the 2006 figures of 76.8 years in men and 81.6 in women. These figures will almost certainly have advanced further at the time of the 2010 census, results of which we are awaiting shortly. When the final results of the 2010 census are reported we anticipate that the sexes will have increased by at least another year in women and perhaps more in men so that the disparity between the two sexes will have narrowed further.

In an attempt to understand the continued improvement in life expectation, which is evident both in Ireland and the UK during the last 50 or more years, it seems worth listing the lifestyle and environmental factors which may account for the continued upward survival trend and which hopefully might contribute  to a reduction in decrepitude among our older citizens. Infant mortality continues to be an important factor, having fallen from 78 per thousand after the war to a remarkable figure of 3 in 2009 and 4 in 2010 in Ireland. The figure of 3 was the lowest ever recorded in these islands. Other epidemic diseases such as polio and deaths from pneumonia contributed, and advances in medical science must receive some credit.

The following list includes the factors which are likely to contribute further to improvement in life expectation. For the sake of discussion I am using  the age of 95 as  the optimum age of humans, that is when 50% of the population will have died from ‘’natural’’ causes, whatever the mode of death is recorded on the death certificate. Such a survival rate is clearly unlikely to be reached, at least in the current world we are living in but clearly there is further room for a further increase in life expectation, both in the first and the third world.

We already have much information about lifestyle and behavioural factors from medical and epidemiological research to allow us to point the way to greater health and longevity and to reducing decrepitude and dependency. As well as the hard research evidence, my opinions are based on my reading, my experience as a physician and a medical epidemiologist, and perhaps a little on common sense.

A further reduction in cigarette smoking or the elimination of the habit would certainly add a few more years to our lives and would leave little or no disparity in the life expectation of men and women. With the recent major reduction of cigarette smoking there is already a marked reduction in heart disease and sudden death, and I expect that lung cancer deaths are or will be in rapid decline.

In countries such as Ireland and the UK changes in eating habits and the nature of the food we eat during the past half century must have been responsible for our improved life expectation. The salt content of commercial food is greatly reduced and has been largely replaced by other less harmful preservatives. In the UK and Ireland there has also been a marked reduction in the use of table salt. Salt is a well recognised cause of stomach cancer and probably other forms of cancer, and is related to high blood pressure.  From being the commonest form of cancer and the most fatal in 1945 when I first qualified as a doctor, this form of cancer has become quite rare thanks to salt reduction and medical intervention in the treatment of stomach ulcers. 

In Ireland too there has been a distinct change to more European types of food with a wider variety choice and more popular use of vegetables and fruit and with less emphasis on domestic meat and other sources of high saturated fat foods. It is well established that vegetarians live longer than meat eaters. Epidemiological studies in Japan and elsewhere confirm that nearly all fish are healthy.  Meat derived from foul and wild birds and animals are less rich in saturated fat. 

It is not possible to measure the exact effect of dietary change on health and longevity but I have little doubt that it is a major factor in the continued improvement in life expectancy during the last 60 years. As regards the efficacy of vitamin supplements and other trace elements, I would suspect that they benefit their commercial  producers more than their customers.

It is well established that the educated enjoy more years than
the uneducated. In one British study third level educated people
gain three extra years over first level. This does not
surprise me. This finding must be based on multiple causes such
as better nutrition, more aerobic exercise, less smoking and
alcohol abuse, and possibly better medical care, although I might
have some doubts about this last factor.

Like education, advances in medicine and changes in medical practice may contribute to a longer life but this is particularly so in the increasing ability to prolong life in the elderly, even at the expense of creating or adding to decrepitude and dependency. The orthopaedic surgeons and eye specialists have contributed, among others, to reducing decrepitude at least if not longevity. The wealthier appear to have better medical care but they are also prone to being exposed to unnecessary medical attention as part of the expensive and widely advertised check-ups by private hospitals and clinics. In an ideal world I believe doctors should treat sick people and government and educators should be responsible for health promotion and prevention, the logical approach to good health in the population.

Another area which can add to years, quality of life and good health is regular aerobic exercise. What is clear from a number of studies worldwide is that regular walking at an optimum rate consistent with comfort for as little as six miles a week provides benefit in slowing ageing, in enhancing mood, in reducing depression and  in improving wellbeing. The more strenuous forms of exercise, such as running, climbing, cycling and aerobic sport are to be recommended too at appropriate ages but walking is sufficient, Your mantra should be Keep Your Legs Strong. Even those of us who have been sedentary up to retirement or later can benefit by adopting an exercise programme of walking and thus enhancing our physical and psychological wellbeing.

The word hygiene is defined in my Random House dictionary as ‘’the science that deals with the preservation of health’’. (Hygeia was the daughter of Asclepius, the goddess of health in Greek mythology)  It is clear that hygiene is related to human longevity. Under this heading I include care of our bodies, our teeth, skin, hair and our physical functions and appearance. And I extend the meaning of the word the avoidance of accidents, a constructive and optimistic outlook, moderation and a rational approach to life and to our relationship with others.

Our greatest challenge is decrepitude among the aged and its prevention. This can only be achieved if we are aerobically active, if we keep our legs strong. Decrepitude and dependency were appropriately described by Ivan Illich as living death. You are likely to avoid a long period of decrepitude and dependency in your last years if you keep aerobically and mentally active.

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