William Penn, 1958 (41. évfolyam, 1-12. szám)

1958-08-06 / 8. szám

Vol. XLI. AUGUST 20, 1958 51 NUMBER 8.

FACTORS IN LONGEVITY

By GEORGE C. TURNBULL, M. D., Associate Professor of Medicine Northwestern University Medical School, Evanston, Illinois

One can not practice medicine for as many years as I have done without a conviction that life has been lengthened as a result of our modern diet and medical therapy. The population of Americans over 65 is increasing at twice the rate of our over-all population rise, which shows the effectiveness of these factors. Thus more people pass beyond the “expected” years into the so-called “sunny side” of life despite war and present day traffic hazards. However, this so-called “sunny side” may not be so good or even welcome as the name given to it would indicate. Specialty groups, pharmaceutical laboratories, educators, public health resources and hospital research are joined to attack every phase of the problem. Advances are steadily being made in the understanding of nutrition, exercise, mental health, recreation and rehabilitation. At national level, medical societies are taking part in an intensified campaign begun 40 years ago to urge periodic physical examinations for all Americans by their family physicians. By this effort, doctors hope to find the very abnormalities which disable a person in advanced years if not detected earlier, too late or not at all. It is the intention in this talk to point out certain factors in longevity that appear more important to this speaker. One must consider the combined economic and social factors as well as some of the known medical facts.

First, let us consider some of these economic and social factors. The American Medical Association states in an article on aging that medicine’s biggest battle is “taming time.” Longer life in itself is not enough. The aim is not merely to prolong man’s life span, but to keep him active. Medicine meets its greatest challenge in helping to bring growth, motivation and fulfillment to a larger majority of the population.

Economic factors become highly important to the older individual since he is usually retired at the age of 65 to a so-called “life of ease.” Assured adequate v.jome. state of health and social adjustment become of great importance. He may have been one of the fortunate 3% of people who has been able to provide adequately in a financial way, but the other large group must have other provisions. Social Security, insurance annuities and pensions too often are inadequate for the extras or unusual long life span. Early in my medical life a forlorn, unhappy dependent maiden patient of mine had a decision to make. She had recently lost her only sister by death, but she was left alone with more than average income at age 66 in the early 1930’s. An insurance salesman had interested her in placing $20,000.00 in an annuity which would pay her monthly installments equalling 10% per year as long as she lived, with no residue after death. This was a difficult decision to make, especially since she had, two devoted nieces who might inherit from her estate. Physically she was malnourished and unhealthy, with known gall bladder disease with stones which had caused recent disability. Advice was difficult to give under these circumstances, but upon considering only the needs of the patient the annuity was purchased so that she had a really g-ood monthly income together with other investments. After' making this step her eyes became brighter, health improved markedly, and she lived most comfortably in the more abundant life. Frankly, she lived 22 years, and when disability did beset her in the last years of life, she was able to be better cared for with her increased funds. When she felt at low ebb mentally, one would need only mention how she was winning from the insurance company to give her a better outlook and bring a ready smile.

I am told that this type of annuity was sold only a few years, but to me this was a good example of an effective way to face the economic problem of growing older, although it, no doubt, lost money for the insurance company. At this same period we had a male patient in the late 60’s with moderate hypertension who had not been able to conserve funds for his old age, in spite of regular employment. His wife had recently died of a neglected gall bladder infection with stones after her refusal of early surgery. When he lost his job due to his age, he accepted the relief program offered by the Roosevelt Administration. His needs were well cared for and one day he appeared at my office, all smiles, to inform me that the social workers thought he should go to California for the winter. This he did and while basking in the sunshine on a California beach, he had a stroke with sudden death. It then looked like the high living provided at public expense proved too much for him.

Today’s biggest medical problem, says Dr. David B. Allman, the new president of the American Medical Association, is how to provide care for people over 65 years. “We doctors are largely responsible for so many people living to be over 65,” he points out; “Now it is up to us to see that these folks get good medical care.” This also means helping to see that they can afford to grow older. All of us must work together in order to accomplish further plans to help accomplish this end.

Homes for the aged can meet the needs for only a very small percentage of the aging g-roup. These homes are mostly fraternal or church owned and can be a welcome haven. The speaker, who has been intimately associated with a church home for the aged over a period of years, also finds that, as a rule, the individual improves in health and prolongs life once he or she is admitted to membership. Everything is taken care of for them after their small entrance payment. Even those among the “living out” group find that the freedom from worry increases their state of health since they realize all further needs will be met by understanding- people who have the member's point of view and need as their prime objective. In most instances the entrance fee is sufficient to only pay their burial costs and all other expense is met by their church through member’s donations.

Socially, the older individual may feel well adjusted in the world, but the

OFFICIAL NOTICE

In accordance with instructions from the Board of Directors, I hereby notify the members of the William Penn Fraternal Association that the next regular semiannual meeting of the Board of Directors will be held the week beginning Monday September 8, 1958.

Any member wishing to transact official business with the Board of Directors should do so by letter addressed to the National Secretary, with the notation, BOARD OF DIRECTORS, on the lower left corner of the envelope.

Communications intended for consideration at this meeting are acceptable until August 30. Any received after the aforementioned date shall be deferred until the next regular session of the Board of Directors.

—COLOMAN REVESZ National President

younger generation look on them as “old folks who are becoming queer or difficult.” Too many times the younger generation seem unable to adequately adjust emotionally or financially in order to accept the care of their aged parents or relatives. In earlier years the older person in the home was an economic necessity. They did the sit-down jobs for the family, but now with so many gadgets and services performed out of the home, the extra pair of hands coupled with tiresome ways are not easily tolerated. In some aieas community groups have effective plans where the retired person has a real place in society. They seemingly do better with those who are their own age as long as they have contact with various age groups in addition to their own.

A plausible solution for the economic and social problems of the aging is suggested by John H. Miller as reported in the September, 1957, issue of the “World Medical Journal.” He states problems of the aged who are ill will be solved by voluntary means only if insurance companies provide medical care insurance and employers use the facilities at their disposal. The ultimate objective should be to insure that the years which have been added to life through reduction in mortality from acute infectious diseases shall not be spent in chronic invalidity. This calls for greater development of disease prevention, the early detection and treatment of chronic disease, the creation or expansion of special facilities and service such as geriatic clinics, nursing and convalescent homes, home care hospital programs, the “day hospital” and other facilities and services especially designed to meet the health problems of the aged. Rehabilitation services should be made available not only to those disabled persons who are potentially re-employable, but to all persons whose well-being can be improved through the techniques of rehabilitation. Accomplishment in these areas will minimize the needs for medical treatment and control its cost, and will complement the advances being made by insurers in expanding the coverage on the older lives.

We can consider known medical facts. With the reduction of mortality from infectious disease, we find heart disease, cancer, and cerebral accidents, followed by cirrhosis of the liver emerging as the leading causes of death. Dietary' methods and exercise aid in control of these diseases (with the exception of cancer, about which we are learning more every day) but will not be included in this brief analysis.

We hear much about the harm of fat in diet and its relationship as a causative factor in degenerative disease. We hear of saturated and non-saturated fats, of their influence on cholesterol levels in the blood and relationship to arteriosclerosis, which accounts for vascular disease. Lipids are frequently designated culprits, and, in some circles the term “fat” and “cholesterol” have become synonymous with hardening of the arteries and disaster. How much is an ideal quantity of fat, and what should be its chemical nature? The fact that precise answers cannot be given to these fundamental questions emphasizes the urgent need for re-examination of the lipids in nutrition. Whether or not dietary fat is, in some fashion, the culprit remains to be proven. Also the alcoholic, with his diet high in alcohol but inadequate in protein and vitamins, often becomes obese and cirrhosis of the liver often results. In the meantime, one may recommend the diet control required to obtain and maintain optimum body weight and the choosing of a varied diet containing adequate amounts of food, including fats, shown by experience and by experiment to have special nutritive values.

Hypertension is a sign of disease just as well as fever or leucocytosis. It occurs in 20% of persons over the age of 40 in the United States. Known cause accounts for 5% of the cases with a remaining 95% with cause unknown. Factors such as heredity and body type play a role. The exact cause is not known, but it is recognized that several neurogenic and endocrine factors are involved. We now possess the means to control blood pressure, if not to cure hypertension.

Diabetes is closely associated with vascular disease in persons 60, 70, and 80 years of age and has become an increasingly important problem. The in(Continued on page 2)