sarah
10-08-2006, 12:57 AM
this is slightly off topic (and I hope this is not inappropriate and I apologise if it is) but I think helpful to understand staying fit and good for us oldies to see:
Piercing mystery of old-age frailty
By Gina Kolata The New York Times
THURSDAY, OCTOBER 5, 2006
NEW YORK 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 6.2 miles in less than 44 minutes, and he is smooth and controlled.
"He's like a metronome with his pacing," Wittenberg says. "I am often struggling to keep up with him, and it's a good day when I do."
While Bialokur's performance would be the envy of most young men, he is not young. Bialokur is 71 years old.
It is one of the persistent mysteries of aging, researchers say.
Why would one person, like Bialokur, remain so hale and hearty while another, who had seemed just as healthy, start to weaken and slow down?
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, 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," 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 or 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 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 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, 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."
Eleanor Simonsick's initiation into the unrecognized debilitations of aging came with a research study she helped design. The question was whether relatively vigorous older people are also longer-lived. 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 70s who said they could walk a quarter of a mile, or just under a half kilometer, 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.
The researchers published their data in the May 3 issue of The Journal of the American Medical Association, concluding 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.
Dorothy Bower used to take walks around the grounds of her assisted living residence in Wilkinsburg, Pennsylvania. But no more. In the past six months, the 78-year-old woman says she has lost her energy. "I make it down the hall and to the dining room," she said.
"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. That takes me about five minutes."
Bower's problem is frailty, doctors said. It is increasingly common as people age, and its symptoms - losing muscle mass and strength and feeling depleted, walking slowly, losing weight and doing less and less in a day - go together, said 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 said.
Gerontologists say the full frailty syndrome is uncommon until people reach their 80s, but its likelihood increases rapidly from then on.
For example, the Cardiovascular Health Study, a national study of more than 5,000 participants age 65 and older, found that 9.5 percent of those aged 75 to 79 were frail. Among those 80 to 84, about 16 percent were frail, and nearly a quarter of those 85 to 89 have the frailty syndrome.
"I would say all 100-year-old people are frail," said Dr. Anne Newman, a professor of epidemiology and medicine at the University of Pittsburgh. "Most 90- year-olds are frail," she added. "And some 80-year-olds are frail."
Newman and her colleagues wondered what could be causing frailty in some but not others. They thought of undetected cardiovascular disease. The idea was that blood flow to the heart or muscle or brain could be impeded even if a person had had no overt signs of cardiovascular disease.
It was a new way to think about cardiovascular disease and a new way to think about aging, Newman said. "With frailty," she said, "the slowing of gait, the loss of muscle strength, we had chalked up to being totally nonpreventable."
Cardiovascular disease may be why Bower became frail. For 60 years, she says, she has had diabetes, a disease that damages blood vessels.
So even though she has not had a heart attack or a stroke, blood flow to her muscles, heart and brain may be impeded, researchers say.
If they are right about frailty, Newman and others say, then the condition may be prevented or delayed by not smoking and keeping cholesterol and blood pressure levels low and by staying active.
Piercing mystery of old-age frailty
By Gina Kolata The New York Times
THURSDAY, OCTOBER 5, 2006
NEW YORK 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 6.2 miles in less than 44 minutes, and he is smooth and controlled.
"He's like a metronome with his pacing," Wittenberg says. "I am often struggling to keep up with him, and it's a good day when I do."
While Bialokur's performance would be the envy of most young men, he is not young. Bialokur is 71 years old.
It is one of the persistent mysteries of aging, researchers say.
Why would one person, like Bialokur, remain so hale and hearty while another, who had seemed just as healthy, start to weaken and slow down?
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, 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," 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 or 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 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 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, 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."
Eleanor Simonsick's initiation into the unrecognized debilitations of aging came with a research study she helped design. The question was whether relatively vigorous older people are also longer-lived. 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 70s who said they could walk a quarter of a mile, or just under a half kilometer, 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.
The researchers published their data in the May 3 issue of The Journal of the American Medical Association, concluding 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.
Dorothy Bower used to take walks around the grounds of her assisted living residence in Wilkinsburg, Pennsylvania. But no more. In the past six months, the 78-year-old woman says she has lost her energy. "I make it down the hall and to the dining room," she said.
"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. That takes me about five minutes."
Bower's problem is frailty, doctors said. It is increasingly common as people age, and its symptoms - losing muscle mass and strength and feeling depleted, walking slowly, losing weight and doing less and less in a day - go together, said 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 said.
Gerontologists say the full frailty syndrome is uncommon until people reach their 80s, but its likelihood increases rapidly from then on.
For example, the Cardiovascular Health Study, a national study of more than 5,000 participants age 65 and older, found that 9.5 percent of those aged 75 to 79 were frail. Among those 80 to 84, about 16 percent were frail, and nearly a quarter of those 85 to 89 have the frailty syndrome.
"I would say all 100-year-old people are frail," said Dr. Anne Newman, a professor of epidemiology and medicine at the University of Pittsburgh. "Most 90- year-olds are frail," she added. "And some 80-year-olds are frail."
Newman and her colleagues wondered what could be causing frailty in some but not others. They thought of undetected cardiovascular disease. The idea was that blood flow to the heart or muscle or brain could be impeded even if a person had had no overt signs of cardiovascular disease.
It was a new way to think about cardiovascular disease and a new way to think about aging, Newman said. "With frailty," she said, "the slowing of gait, the loss of muscle strength, we had chalked up to being totally nonpreventable."
Cardiovascular disease may be why Bower became frail. For 60 years, she says, she has had diabetes, a disease that damages blood vessels.
So even though she has not had a heart attack or a stroke, blood flow to her muscles, heart and brain may be impeded, researchers say.
If they are right about frailty, Newman and others say, then the condition may be prevented or delayed by not smoking and keeping cholesterol and blood pressure levels low and by staying active.