JOURNAL OF THE
american VOLUME XXVl
N O V E M B E R 1978
N U M B E R 11 Printed ~n U . S . A .
Copyright 0 1978 by t h e American Geriatrics Society
Health Habits in Relation to Aging FRANK B. McGLONE, MD”” and ELLA KICK, RN, MSNi Medical Care and Research Foundation, Denuer, Colorado
ABSTRACT: A review of the literature and a study of 52 patients of the 80+ age group confirmed the premise that good health habits have a positive effect on the quantity and quality of life. Not all persons can live beyond 80, but those who do can lead a better life if they live properly. A profile of these 52 subjects aged 80 or older revealed that they were of average size or thin, and of a happy temperament; they ate well and regularly, slept adequately, avoided excessive amounts of alcohol, did not smoke, used drugs sparingly, and led a n active life, physically and mentally. Also, it was apparent that the rugged elderly can withstand the impact of a major illness or a surgical operation with associated anesthesia. The following factors are important for longevity: 1) pick the right grandparents, 2) keep active physically and mentally, 3) eat properly, 4) stay thin, 5) drink alcohol moderately if at all, and 6) do not smoke. Various studies have pursued the value of living long, and have tried to discover the secret of youth. Lorand (1) in Austria in 1911 and Humphrey (2) in the United Kingdom in 1889 spoke of Thomas Parr who died a t age 153. They also discussed the qualities that lead to great age in reviewing the health habits of 52 persons who lived 100 years or longer.
The British (2) reported the qualities that lead to great age as follows: “A good family history; a well-made frame of average stature ( 5 feet 8, which is rather above the average, in the male, 5 feet 3 in the female); spare rather than stout, throughout life robust, with good health, little troubled with ailments or illnesses of any kind, with good digestion, regular daily action of bowels; active, capable of much exertion, with the restorative advantages of good sound sleep permitting or inducing early rising (not one is reported to have been a ‘bad’ sleeper, and nearly all were ‘early risers’); good vocal organs; a good appetite moderately indulged, with little need of, and little consumption of, alcohol or animal food; a n energetic yet placid temperament; a good intelligence; the hair holding its growth and its colour well; the organs of sight and
* Presented at the 35th Annual Meeting of The American Geriatrics Society. Hyatt Regency Hotel, Atlanta, GA, April 13-14, 1978. ** Executive Director, Medical Care and Research Foundation; G~~steroenterolob.ist. T h e Denver Clinic, Denver, CO. (President. Western Division of The American Geriatrics Society.) Address for c,orr-c..s~onr~c.n(e: F r a n k R . McGlone, MD, The Denver Clinic, 701 East Colfax Avenue, Denver, CO 80203. t Research Assistant, Medical Care and Research Foundation.
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hearing performing their functions well and long. Some retained great activity to the end. One woman ‘danced and sang on her 10lst birthday’; another ‘received the holy communion in Church on her 100th birthday’; a third ‘walked in the hay-field and amused herself making hay on her 100th birthday’; and a man aged 101 had ‘walked a t least 4 miles the day before the return was filled up.’ ” Lorand (1) recommended 12 precepts for longevity. (He quoted Seneca; “Man does not die, he kills himself.”) “Most of the evils that befall us in this world, including premature old age and early death, are, in our opinion, as often repeated, solely due to our negligence; and to avoid such a fate we recommend the following precepts: 1. To be much as possible in the open air, and especially in the sunshine; and to take plenty of exercise, taking special care to breath deeply and regularly. 2. To live on a diet consisting of: meat once a day, eggs, cereals, green vegetables, fruit, and raw milk of healthy cows (as much as the stomach will permit); and to masticate properly. 3. To take a bath daily; and in addition, once a week or once every two weeks, to take a sweat bath (if the heart can stand it). 4. To have a daily action of the bowels; and in addition to take a purgative once a week if there is any tendency to constipation. 5. To wear very porous underwear, preferably cotton; porous clothing, loose collars, light hat (if any), and low shoes. 6. To go to bed early and to rise early. 7. To sleep in a very dark and very quiet room, and with a window open; and not to sleep less than six to six and one-half hours, or more than seven and one-half, and for women eight and one-half hours. 8. To have one complete day’s rest in each week, without even reading or writing. 9. To avoid mental emotions, and also worries about things that have happened and cannot be altered, as well as about things that may happen. Never to say unpleasant things, and to avoid listening to such, if possible. 10. To get married; and if a widow or widower, to marry again; and to avoid sexual activity beyond the physiological limit, as also to avoid a total suppression of the functions of these organs. 11. To be temperate in the use of alcohol and tobacco, and also in the use of coffee or tea. 12. To avoid places that are overheated, espe-
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ND KICK
cially by steam, and badly ventilated. To replace or reinforce the functions of the organs which may have become changed by age or disease, by means of the extracts from the corresponding organs of healthy animals; but only to do this under the strict supervision of medical men who are thoroughly familiar with the functions of the ductless glands.” Several good longitudinal studies have been made and are under way: Granick and Patterson (3), Busse and Pfeiffer (4), Eichorn (5) and Shock (6) (Baltimore Longitudinal Study of Aging). These studies for the most part involve the relation of physical and laboratory findings to illness in aging and include an analysis of psychosocial problems in aging. Belloc (7) in California studied patients in relation to the effect of seven simple health habits on longevity. These health habits were: eating breakfast, no snacking between meals, getting adequate sleep, maintaining weight a t a desirable level, drinking less than four ounces of alcohol a day, getting an adequate amount of exercise, and not smoking. In Belloc’s study the relative values of different health habits were not appraised, and some seem more significant than others. However, he did find that persons who had five or more of the good health habits lived longer than those with less than five, and those who had less than three had a shorter life expectancy than the intermediate group. Leaf (8) has written about his visits to areas in the world which are known for the high incidence of persons living to an extraordinary age. He visited West Pakistan, Ecuador, and Georgia in the Soviet Union. In these places there was a reasonably high percentage of inhabitants who were elderly and many who were over 100 years of age. Common to all three areas were the facts that these old people usually were underweight, their caloric intake was low, and the diets were relatively low in fats and carbohydrates. In addition, in all three areas the old people were active physically, most of them having to live off the land, using very rustic equipment. They also lived a t an altitude of 4,000 feet or higher. Obviously, many other factors that affect the quantity and quality of life should be evaluated. HEALTH HABITS AND AGING
Mental activity Cruikshank (9) a t a meeting of the American Academy of Science in 1975 spoke about the 46
November 1978
HEALTH HABITS IN
men who signed the Declaration of Independence. It is remarkable that they were relatively young men when they drew up this document, but it is also remarkable that many of them lived long and useful lives. This was particularly significant since life expectancy in the 18th century was less than 50 years. Of these 56 men, five lived into their go’s, and a t least nine lived into their 80’s. The average age a t death was 67 years. If we exclude one man from South Carolina who died in an accident at sea a t the age of 30, the average age a t the time of death was 68. These men, having achieved the independence of their country and having started a new nation, could well have retired and relaxed, but they didn’t. John Adams was very active until his death a t the age of 91. Samuel Adams lived to be 81, after a very active life. Thomas Jefferson lived to be 83, and after his revolutionary activities was Minister to France, was Secretary of State under George Washington, was President for two terms, and up to his death maintained an active correspondence. Benjamin Franklin, who was 70 a t the signing of the Declaration, lived to be 84. He served in the Constitutional Convention a t the age of 83, the year before he died. He was also very active in many other ways.
Nutrition, Belloc (71, in his study of the relation of health habits to aging, listed snacking between meals as a poor health habit. In an aging population this may actually be a good habit. Stare (lo), in the Henderson Lecture presented a t the 1977 Annual Meeting of the American Geriatrics Society, pointed out that for some people, eating five small meals per day is better than eating three large meals. Also, diets low in calories and high in roughage improve the nutritional status of older persons. The classic studies of McCay et a1 (11)a t Cornell University in the 1930’s showed that the lifespan of albino rats could be increased as much as 40 percent by restriction of caloric intake early in life. Leaf (8) found that the centenarians in the countries he visted were lean and lived on low calorie diets. In the study of 900 persons over age 80 in the United Kingdom (21, few were found to be obese. There is some evidence, however, that obesity may not be of as great significance as previously believed. The famous Thomas Parr (1, 2) lived on a low calorie diet consisting of skimmed cheese, milk in every form, coarse hard
SLATION TO AGING
bread, small beer and sour whey. His death a t age 152 was attributed to a change in eating habits. A few years before his death he was brought to London by the Earl of Arundell, who presented him to the King. He partook heartily of rich food and good wines during this period. The physicians of his day felt that this overeating was a significant factor in his death.
Exercise Physical exercise is an important adjunct to the quality, and probably the prolongation, of life. Important in the lives of 52 English centenarians (2) were their life habits. Outstanding among these habits were activity, outdoor exercise, early rising, and moderation in diet and in the use of alcohol. These evidently were factors in longevity. According to the comments in this study, most of these habits could be regarded as attributes of the well-wearing body, i.e., they were the resultants of‘ health as well as the promoters of it. The healthy, vigorous body can scarcely be otherwise than active. Few things tend to promote health and vigor more than activity - activity without excitement, activity which is not forced beyond the measure of good and easy repair, and which does not wear out the body. The candle ought to burn briskly, but not too fast. It should be emphasized that most of these centenarians had been accustomed to much outdoor exercise, with the refreshing influence of open air. Exercises and athletics indoors, where they are much more exhausting, are not a sufficient substitute, especially in the case of young and growing persons. In this country, fortunately, the population is becoming exercise conscious. Hodgson and Buskirk (12), a t the 1977 Annual Meeting of the American Geriatrics Society, reviewed the literature and pointed out that the effects of exercise should be further investigated. Beverley (131, a t a meeting of the National Association for Human Development in Washington, DC, described exercise programs for older persons and a model program for those over the age of 60. There is no doubt that exercise is beneficial. Additional studies are needed to determine the appropriate type of exercise and the amount of benefit. To be of optimal benefit, the exercise programs should be tailored to fit the abilities and pleasure of the individual.
Emotional factor3 Emotional factors are of considerable impor483
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tance in the quality of life during aging. They were not included in Belloc’s report, but they are significant in relation to health. Denes (141, in Hungary, studied the “old age emotions” of 100 persons in the 60-94 age group. The chief factors leading to emotional sterility were loneliness, retirement, and a decrease in sensory and locomotory functions. Among the 100 subjects, 60 were optimists and 40 were pessimists, and most of the pessimists were lonely. Humor A sense of humor is most important. One of the patients recently studied by us, an 84-yearold woman whose previously heavy breasts had shrunk to a mere shell, described her breasts as “basset hound ears.” Braceland (151, a senior consultant to the Institute of Living a t Hartford, Connecticut, wrote in his personal reflections on growing older, several things that helped him to age gracefully (and should help us in the same fashion): “I’ve passed another hurdle-I’m 75 and I’m starting on the last quarter. This time they tell me that when the coach takes you out, they don’t bench you-they plant you! As a precaution, therefore, when I put an envelope in the Sunday collection basket now, it is not a contribution - it is an investment. I’m anxious, of course, to end up in heaven, but I’m holding back, waiting for a lower entrance requirement. “I think I have recorded several times the fact that for years, in the still of the night, I could hear the cells dropping out of my cortex and drowning in the excess fluid in the widened sulci; I would hear them going down for the third time and it kept me awake. Well, that’s all over now-I don’t hear them any more. The cells apparently are all gone; I’m working on white matter, now gristle, and I’m on what the bankers and economists call the bottom line. “I will admit that my memory is not what it used to be. I have to fish for words, and my thingamabob, which used to contain thousands of words, has contracted a bit. I find I have to use roundabout methods to cover up. For instance, yesterday, I forgot the word ‘key’ and had to quickly make up a sentence about opening the door. I signed up for a memory course in town, and on coming out, I couldn’t remember where I had parked my car; by the second lesson I had forgotten where the place was, so I had to quit. Every year it seems the FDA makes the drug
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companies recall more, and I recall less. “I thought by this time I would have found the answers to some of the questions that have bugged me through the years and believed that for a while that I had, but now, unfortunately, I’ve even forgotten the questions. I have reached the age now when I have to put on my glasses and slippers and sit down in order to think. I have three pairs of glasses; one for distance, one for close-up work, and one to help me find the other two. It’s when I find them and can’t remember why I wanted them that I get upset. I rest on my laurels and, incidentally, that part of my anatomy has gotten broader even as my mind has gotten narrower. “I know I was getting old; recently when I looked at a picture of a horse for five minutes I missed the fact that Lady Godiva was on it. By the way, do you remember what Lord Godiva said on that occasion? He said, ‘I’ve got a bundle riding on that horse.’ Funny, I remember this historical things when I can’t remember what I had for breakfast.” Retirement Retirement also has an effect on the quality of life. Most studies on happy longevity indicate the importance of physical and mental activities. Many such articles point out the disadvantage of early retirement for many persons. Page (16) stated that a nationwide survey showed that more than three-fourths of those listed in “American Men and Women of Science” were interested in continuing scientific work after mandatory retirement; 40 percent of those over 81 were working. Others have reported that the United States has not been prepared for the retirement boom, and we are certainly unprepared for the growing number of people over age 65. Years ago there were seven working people for every retired person. Today that ratio has decreased to only two or three working people who are supporting one retiree. Individuals who no longer have a necessary role in the social and economic life of their society can deteriorate very rapidly. Retirement is a fertile field for the distortion of emotional life. It also seems that there is an unexpected increase in physical illness among retirees at any early age. Sex The quality of life in advancing age is frequently intertwined with sexual activity. In
November 1978
HEALTH HABITS IN RELATION TO AGING
most societies the combination of males boasting of sexual prowess and the taboos against discussing the subject has made it difficult to collect reliable information about sexual activity in the elderly. We do know that sexual activity need not cease. Benjamin Franklin was a very busy man in many ways. He had a sense of humor and he appreciated the value of sex. He also recognized that in the aging population, the women outnumbered the men. In his “Old Mistresses Apol o p e , ” Franklin (17) suggested what may become a solution to the statistical imbalance of women versus men in the older population. In essence, he felt the older women and young men are ideally suited for one another. Many of these arguments would brand him as a male chauvinist in today’s world, but he numerated eight reasons why old women make good lovers. First, because as they (older women) have more knowledge of the world and their minds are better stored with observations. Their conversation is more improving and more lastingly agreeable. Second, because when women cease to be handsome, they study to be good. To maintain their influence over men, they supply the diminution of beauty by an augumentation of utility. They learn to do a thousand services, small and great, and are the most tender and useful of all friends when you are sick, thus they continue amiable, and hence there is hardly such a thing to be found as an old woman who is not a good woman. Third, because there is no hazard of children, which irregularly produced, may be attended with much inconvenience. Fourth, because through more experience they are more prudent and discreet in conducting a n intrigue to prevent suspicion. The commerce with them is therefore safer with regard to your reputation; and with regard to theirs, if the affair should happen to be known, considerate people might be rather inclined to excuse an old woman who would kindly take care of a young man, form his manners by her good counsels, and prevent his ruining his health and fortune among mercenary prostitutes. Fifth, because in every animal that walks upright, the deficiency of fluids that fill the muscles appears first in the highest part: the face first grows lank and wrinkled; then the neck, breasts and arms; the lower parts continuing to the last as plump as ever: so that covering all above with a basket, and regarding only what is below the girdle, it iq impossible of two women to know an old from a young one, and as in the dark all cats are grey, the pleasure of corporal
enjoyment with an old women is at least equal, and frequently superior, every knack being by practice capable of improvement. Sixth, because the sin is less. The debauching of a virgin may be her ruin, and make her for life unhappy. Seventh, because the compunction is less. The having made a young girl miserable may give you frequent bitter reflections, none of which can attend the making of an old woman happy. Eighth and lastly. They are so grateful!! Thomas Parr was famous in many countries. The Austrian literature reported that he was accused of having committed a sexual offense in his 102nd year, for which he was found guilty and punished. The following is the report (2) on his postmortem examination: “Of the postmortem examinations which have been recorded (they are unfortunately but few), the first and best known, so far as I am aware, is that of Thomas Parr, aged 152 years and 9 months, made by Dr. William Harvey, famous for his discoveries respecting the circulation of the blood, by command of the King (Charles I). The body was muscular, the chest and forearms hairy, the hair still being black, but the legs without hair. Organs of generation healthy; penis not retracted or extenuated; testes sound and large [so that it seemed not improbable that the common report was true, namely that he did public penitence, under a conviction for incontinence, after he had passed his 100th year; and his wife, whom he had married in his 120th year, did not deny that he had intercourse with her, after the manner of other husbands with their wives.] The chest was broad and ample; the lungs, nowise fungous, adhered, especially on the right side, to the ribs; heart large, thick and fibrous, with considerable quantity of fat; cartilages of ribs soft and flexible; stomach and intestines and all of the viscera sound; kidneys healthy, with the exception of a few watery cysts; no appearance of stone in them or in the bladder; spleen very small, scarcely equalling one of the kidneys; a good deal of fat about the mesentery, omentum and kidneys; brain healthy, firm and hard to the touch.” At the turn of the century healthy sex organs were considered essential to a long life. The elasticity of the thoracic cage and arcus senilis were considered important physical signs in evaluating aging. REVIEW OF PATIENTS As a result of our experiences and a review of
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the literature, we believe that the various health habits discussed are significant. We studied 52 patients over 80 years of age in some detail, to try to evaluate their state of health in relation to various factors including health habits. Although the 52 subjects were drawn a t random, they were limited to the group who could carry out the activities of daily living. We included the seven health habits studied by Belloc in addition to other habits considered to be significant. It is interesting that the 1889 study in the United Kingdom (2) involved longevity in relation to most of the same factors. Their study of 900 patients over age 80 was carried out by means of a questionnaire to doctors who were willing to respond. The following is a summary of our findings, and some comparisons with the findings in the United Kingdom report: Sleep. The sleep habits of most of the subjects were quite good. Almost all slept from 6-10 hours and very few used any sedation. The United Kingdom group showed similar characteristics regarding sleep. Nutrition. Most of the subjects were of normal weight, or thin. In the United Kingdom the terms “spare, average and fat” were used and in their group there were 114 spare, 182 normal and 37 fat people in the 80-90 group; in the 90-100 group, 99 were either normal or thin and 10 were fat. We did not have any truly obese persons in our study. Smoking is probably a more important health habit than some of the ones mentioned previously. In our group of 52 subjects, 47 were nonsmokers and only one was a heavy smoker. There was no comparable material in the United Kingdom study except in the 100+ group; of 45 who reported, 7 smoked a great deal, and 4 of these were women; 32 did not smoke; 5, including one woman, used snuff. Ph.ysica1 actiuit.y. Most of our oldsters were active, and 40 of the 52 were active both physically and mentally. Twelve were inactive, chiefly because of disabling arthritis or cardiovascular disease. In this group was a 90-year-old man who for 50 years played (walked) 18 holes of golf three times a week and continues to do so! Another man was very active in throwing a baseball, until the age of 90. One woman skied until she was more than 80 years old. Alcohol. In our group there were no heavy partakers of alcohol; 21 were abstainers. In the United Kingdom group, 20 of about 400 who were heavy drinkers, lived past the age of 80. One
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woman drank so much that she was locked up 200 times. Her father died of alcoholism (a drunk) a t age 90. There are always exceptions to any rule. We are always hearing of the centenarian who drinks and smokes. Lorand (1) from Austria reported this colorful exception: “A strong point against the anti-alcohol faddists is the case of Brown, an Irish peasant, who after many years of heavy beer drinking, attained the age of 120. His tombstone exhibits the following epitaph: ‘Here lies Brown, who became 120 only through the strong beer he was drinking. He was constantly drunk, and in this condition so terrible, that even death was afraid of him. When, however, one day contrary to his habits he was sober and in a quiet mood, death got courage, seized him, and thus a t last was triumphant.’ ” Heredity is significant. For all but one of the subjects in our study, the parents lived past the age of 70. Retirement. We were not able to determine either harmful or beneficial effects from retirement, although it is well known that retirement does have a negative effect in some instances. Most of our group led active lives after retirement. Blood pressure. Among the 52 subjects, 19 had a n elevated blood pressure, but only five had significant hypertension. We could make no comparisons with the United Kingdom 1899 study because blood pressure was not routinely measured a t that time. Laboratory findings did not conform to any significant pattern. Only two of the subjects had a high serum cholesterol level, and uric acid values usually were normal. The blood glucose findings did not indicate diabetes. Emotions. The emotional aspect was important in relation to the quality of health in our group. Five subjects were classified by us and our other observers as depressed or pessimistic; 46 were considered to be happy, with an optimistic outlook on life. Major illnesses. Some studies have shown that a major illness in the aged often is followed by death within a year. This did not happen in our group. Tables 1 and 2 show the major medical illnesses that occurred in patients past the age of 60. The results indicate that those who live to be 80 are probably more rugged and survive serious illnesses. Multiple problems. One of the important aspects of geriatrics is the number of concomitant diseases found in old people. Table 3 shows the
HEALTH HABITS IN RELATION TO AGING
Noveniher 1978
-
TABLE 1 Mujor Mcdiccil Illnesses in Patients Past Age 60 -~ ~~~
~
~~
~
~~~~~
~
Illness ~-
~
~~
~~
~~
-
Age of Patients (yrs.) ~
~
~
68 76 80 & 84 83 & 90 80, 84 & 85 79 77, 79, 81, 87 66 81 83 & 89
.-
TABLE 2 Mqlor Surgical Procedures in Patients Past Age 60
_ _ Age of Patients (yrs.)
~~~
Surgical Procedure _. -~
Nephrectomy Colon resection (colon CAI Aortic aneurysm resection Small-bowel resection Hysterectomy Cholecystectomy Cystocele Fractured hip Appendectomy Perineal repair Cataract Thyroidectomy Laryngeal neoplasm Prostate Slipped disc repair Dilatation & curettage Partial gastrectomy Bunionectomy _. ~. .~
No. of Patients 12 9 12 6 8 2 2
~~
Anesthetics (1 a t age 96) 35 patients Multiple illnesses 6 patients Many emotional crises over sudden deaths of spouses or children
~
No. of Drugs
-~
Carcinoma stomach Carcinoma endometrium Robbedandbeaten Herpes zoster Pulmonary embolus Myocardial infarction Transient ischemic attacks Subacute bacterial endocarditis Carcinoma cervix Cardiovascular accident
-~
TABLE 4 Numher of Drugs (incl. Over-the Counter) Taken h,y the 52 Patients 0 1 2 3 4 5
7 8 ~
~
~
1 ~~~
~
~
~
~
lenol (acetaminophen)I. Physical findings. Many of the findings on physical examination could not be adequately included in this study. Several physical changes that are not life-threatening can interfere with the quality of life. Of special significance is the decrease in sensation. This involves decreases in vision, hearing, taste, smell, thirst, and touch. Such changes can affect nutrition.
~
65 80 69 80 & 81 66, 69, 77, & 76 57, 66 & 66 84 80, 81, 83, 86, 87 & 94 74 76 & 84 71, 73, 87 75 & 79 77 76, 81, 84 & 98 77 70 66 66
TABLE 3 Number of Diagnoses in 52 Patients over 80 Years of Age Diagnosis
Number
Cardiovascular Gastroinestinal Genitourinary Skeletal Eye and ear Miscellaneous Total
120 79 34 57 41 62 393
diagnoses in our group. For the 52 subjects there were 393 diagnoses, i.e., an average of 7+ significant illnesses per patient. Drugs. Table 4 shows the numerical distribution of the drugs (including over-the-counter items) taken by the patients. It is encouraging that there was an average of only two drugs per patient, and only three patients were taking more than four drugs [including aspirin or Ty-
COMMENT
A profile of our healthy subjects over age 80 would be similar to that observed in the 1889 study in the United Kingdom. In any longitudinal study related to health habits, the effects of sensation on health and the effects of health habits should be examined in detail. The factors evaluated in this study did not necessitate elaborate or expensive equipment. The average physician in his office can use the information related to health habits to educate his patients. There are many health habits that influence the quality and the length of life, e.g., heredity, physical and mental status, and physiologic changes. Most of our over-80 subjects were of average weight or thin, and had good sleep patterns. They were active mentally and physically. Most of them did not smoke and used alcohol sparingly. Almost all were cheerful, optimistic, and had a good sense of humor. Further study on the effect of health habits on aging is indicated. REFERENCES 1. Lorand A: Old Age Deferred. Philadelphia, FA Davis, 1911. 2. Humphrey GM: Old Age. Cambridge, Macmillan and Bowes, 1889. 3. Granick S and Patterson RD: Human aging. 11, U. S. Dept. Health, Education, and Welfare, Public Health Service, Rockville, Maryland, 1976. 4. Busse EW and Pfeiffer E: Behavior and Adaptation in Late Life. Boston; Little, Brown & Co, 1977.
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5. Eichorn DH: The Berkeley longitudinal studies:continuities and correlates of behavior, Canad J Behavioral Sci 5: 298, 1973. 6. Shock N: Baltimore Longitudinal Study of Aging. Baltimore City Hospitals, Baltimore, MD. 7. Belloc NB: Relationship of health practices and mortality. Preventive Med 2: 67, 1973. 8. Leaf A: Life a n d Death and Medicine. ( A Scientific American book.) San Francisco, WH Freeman & Co, 1973, pp 29-36. 9. Cruikshank NH: Commentary on care of t h e elder1y:meeting t h e challenge of dependency, in Proceedings of a Conference at National Academy of Sciences, Washington, DC, May 17-19, 1976. New York, Academic Press, 1977. 10. Stare FJ: Three score and ten plus more, J Am Geriatrics SOC, 25: 529, 1977.
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11. McCay CM and Crowell MF: Effect of retarded growth upon length of life span and upon ultimate body size, J Nutrition 10: 63, 1935. 12. Hodgson J L and Buskirk ER: Physical fitne J Am Geriatrics SOC 25: 385, 1977. 13. Beverley E V The mechanics of putting those little-used muscles in motion, Geriatrics 31: 132, 1976. 14. Denes Z: Old-age emotions, J Am Geriatrics SOC 24: 465, 1976. 15. Braceland FJ: Personal reflections on growing older, The Critic 35 (3):66, (Spring) 1977. 16. Page IH: Must a n abundance of forms mean a n absence of contentment? (Editorial), Mod Medicine 44: 8, 1976. 17. Franklin B: Old Mistresses Apologue, in Literature of t h e Early Republic (2nd edition), ed. by E H Cady. New York; Holt, Rinehart and Winston, Inc. 1969, pp 404406.
american VOLUME XXVl
N O V E M B E R 1978
N U M B E R 11 Printed ~n U . S . A .
Copyright 0 1978 by t h e American Geriatrics Society
Health Habits in Relation to Aging FRANK B. McGLONE, MD”” and ELLA KICK, RN, MSNi Medical Care and Research Foundation, Denuer, Colorado
ABSTRACT: A review of the literature and a study of 52 patients of the 80+ age group confirmed the premise that good health habits have a positive effect on the quantity and quality of life. Not all persons can live beyond 80, but those who do can lead a better life if they live properly. A profile of these 52 subjects aged 80 or older revealed that they were of average size or thin, and of a happy temperament; they ate well and regularly, slept adequately, avoided excessive amounts of alcohol, did not smoke, used drugs sparingly, and led a n active life, physically and mentally. Also, it was apparent that the rugged elderly can withstand the impact of a major illness or a surgical operation with associated anesthesia. The following factors are important for longevity: 1) pick the right grandparents, 2) keep active physically and mentally, 3) eat properly, 4) stay thin, 5) drink alcohol moderately if at all, and 6) do not smoke. Various studies have pursued the value of living long, and have tried to discover the secret of youth. Lorand (1) in Austria in 1911 and Humphrey (2) in the United Kingdom in 1889 spoke of Thomas Parr who died a t age 153. They also discussed the qualities that lead to great age in reviewing the health habits of 52 persons who lived 100 years or longer.
The British (2) reported the qualities that lead to great age as follows: “A good family history; a well-made frame of average stature ( 5 feet 8, which is rather above the average, in the male, 5 feet 3 in the female); spare rather than stout, throughout life robust, with good health, little troubled with ailments or illnesses of any kind, with good digestion, regular daily action of bowels; active, capable of much exertion, with the restorative advantages of good sound sleep permitting or inducing early rising (not one is reported to have been a ‘bad’ sleeper, and nearly all were ‘early risers’); good vocal organs; a good appetite moderately indulged, with little need of, and little consumption of, alcohol or animal food; a n energetic yet placid temperament; a good intelligence; the hair holding its growth and its colour well; the organs of sight and
* Presented at the 35th Annual Meeting of The American Geriatrics Society. Hyatt Regency Hotel, Atlanta, GA, April 13-14, 1978. ** Executive Director, Medical Care and Research Foundation; G~~steroenterolob.ist. T h e Denver Clinic, Denver, CO. (President. Western Division of The American Geriatrics Society.) Address for c,orr-c..s~onr~c.n(e: F r a n k R . McGlone, MD, The Denver Clinic, 701 East Colfax Avenue, Denver, CO 80203. t Research Assistant, Medical Care and Research Foundation.
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hearing performing their functions well and long. Some retained great activity to the end. One woman ‘danced and sang on her 10lst birthday’; another ‘received the holy communion in Church on her 100th birthday’; a third ‘walked in the hay-field and amused herself making hay on her 100th birthday’; and a man aged 101 had ‘walked a t least 4 miles the day before the return was filled up.’ ” Lorand (1) recommended 12 precepts for longevity. (He quoted Seneca; “Man does not die, he kills himself.”) “Most of the evils that befall us in this world, including premature old age and early death, are, in our opinion, as often repeated, solely due to our negligence; and to avoid such a fate we recommend the following precepts: 1. To be much as possible in the open air, and especially in the sunshine; and to take plenty of exercise, taking special care to breath deeply and regularly. 2. To live on a diet consisting of: meat once a day, eggs, cereals, green vegetables, fruit, and raw milk of healthy cows (as much as the stomach will permit); and to masticate properly. 3. To take a bath daily; and in addition, once a week or once every two weeks, to take a sweat bath (if the heart can stand it). 4. To have a daily action of the bowels; and in addition to take a purgative once a week if there is any tendency to constipation. 5. To wear very porous underwear, preferably cotton; porous clothing, loose collars, light hat (if any), and low shoes. 6. To go to bed early and to rise early. 7. To sleep in a very dark and very quiet room, and with a window open; and not to sleep less than six to six and one-half hours, or more than seven and one-half, and for women eight and one-half hours. 8. To have one complete day’s rest in each week, without even reading or writing. 9. To avoid mental emotions, and also worries about things that have happened and cannot be altered, as well as about things that may happen. Never to say unpleasant things, and to avoid listening to such, if possible. 10. To get married; and if a widow or widower, to marry again; and to avoid sexual activity beyond the physiological limit, as also to avoid a total suppression of the functions of these organs. 11. To be temperate in the use of alcohol and tobacco, and also in the use of coffee or tea. 12. To avoid places that are overheated, espe-
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cially by steam, and badly ventilated. To replace or reinforce the functions of the organs which may have become changed by age or disease, by means of the extracts from the corresponding organs of healthy animals; but only to do this under the strict supervision of medical men who are thoroughly familiar with the functions of the ductless glands.” Several good longitudinal studies have been made and are under way: Granick and Patterson (3), Busse and Pfeiffer (4), Eichorn (5) and Shock (6) (Baltimore Longitudinal Study of Aging). These studies for the most part involve the relation of physical and laboratory findings to illness in aging and include an analysis of psychosocial problems in aging. Belloc (7) in California studied patients in relation to the effect of seven simple health habits on longevity. These health habits were: eating breakfast, no snacking between meals, getting adequate sleep, maintaining weight a t a desirable level, drinking less than four ounces of alcohol a day, getting an adequate amount of exercise, and not smoking. In Belloc’s study the relative values of different health habits were not appraised, and some seem more significant than others. However, he did find that persons who had five or more of the good health habits lived longer than those with less than five, and those who had less than three had a shorter life expectancy than the intermediate group. Leaf (8) has written about his visits to areas in the world which are known for the high incidence of persons living to an extraordinary age. He visited West Pakistan, Ecuador, and Georgia in the Soviet Union. In these places there was a reasonably high percentage of inhabitants who were elderly and many who were over 100 years of age. Common to all three areas were the facts that these old people usually were underweight, their caloric intake was low, and the diets were relatively low in fats and carbohydrates. In addition, in all three areas the old people were active physically, most of them having to live off the land, using very rustic equipment. They also lived a t an altitude of 4,000 feet or higher. Obviously, many other factors that affect the quantity and quality of life should be evaluated. HEALTH HABITS AND AGING
Mental activity Cruikshank (9) a t a meeting of the American Academy of Science in 1975 spoke about the 46
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men who signed the Declaration of Independence. It is remarkable that they were relatively young men when they drew up this document, but it is also remarkable that many of them lived long and useful lives. This was particularly significant since life expectancy in the 18th century was less than 50 years. Of these 56 men, five lived into their go’s, and a t least nine lived into their 80’s. The average age a t death was 67 years. If we exclude one man from South Carolina who died in an accident at sea a t the age of 30, the average age a t the time of death was 68. These men, having achieved the independence of their country and having started a new nation, could well have retired and relaxed, but they didn’t. John Adams was very active until his death a t the age of 91. Samuel Adams lived to be 81, after a very active life. Thomas Jefferson lived to be 83, and after his revolutionary activities was Minister to France, was Secretary of State under George Washington, was President for two terms, and up to his death maintained an active correspondence. Benjamin Franklin, who was 70 a t the signing of the Declaration, lived to be 84. He served in the Constitutional Convention a t the age of 83, the year before he died. He was also very active in many other ways.
Nutrition, Belloc (71, in his study of the relation of health habits to aging, listed snacking between meals as a poor health habit. In an aging population this may actually be a good habit. Stare (lo), in the Henderson Lecture presented a t the 1977 Annual Meeting of the American Geriatrics Society, pointed out that for some people, eating five small meals per day is better than eating three large meals. Also, diets low in calories and high in roughage improve the nutritional status of older persons. The classic studies of McCay et a1 (11)a t Cornell University in the 1930’s showed that the lifespan of albino rats could be increased as much as 40 percent by restriction of caloric intake early in life. Leaf (8) found that the centenarians in the countries he visted were lean and lived on low calorie diets. In the study of 900 persons over age 80 in the United Kingdom (21, few were found to be obese. There is some evidence, however, that obesity may not be of as great significance as previously believed. The famous Thomas Parr (1, 2) lived on a low calorie diet consisting of skimmed cheese, milk in every form, coarse hard
SLATION TO AGING
bread, small beer and sour whey. His death a t age 152 was attributed to a change in eating habits. A few years before his death he was brought to London by the Earl of Arundell, who presented him to the King. He partook heartily of rich food and good wines during this period. The physicians of his day felt that this overeating was a significant factor in his death.
Exercise Physical exercise is an important adjunct to the quality, and probably the prolongation, of life. Important in the lives of 52 English centenarians (2) were their life habits. Outstanding among these habits were activity, outdoor exercise, early rising, and moderation in diet and in the use of alcohol. These evidently were factors in longevity. According to the comments in this study, most of these habits could be regarded as attributes of the well-wearing body, i.e., they were the resultants of‘ health as well as the promoters of it. The healthy, vigorous body can scarcely be otherwise than active. Few things tend to promote health and vigor more than activity - activity without excitement, activity which is not forced beyond the measure of good and easy repair, and which does not wear out the body. The candle ought to burn briskly, but not too fast. It should be emphasized that most of these centenarians had been accustomed to much outdoor exercise, with the refreshing influence of open air. Exercises and athletics indoors, where they are much more exhausting, are not a sufficient substitute, especially in the case of young and growing persons. In this country, fortunately, the population is becoming exercise conscious. Hodgson and Buskirk (12), a t the 1977 Annual Meeting of the American Geriatrics Society, reviewed the literature and pointed out that the effects of exercise should be further investigated. Beverley (131, a t a meeting of the National Association for Human Development in Washington, DC, described exercise programs for older persons and a model program for those over the age of 60. There is no doubt that exercise is beneficial. Additional studies are needed to determine the appropriate type of exercise and the amount of benefit. To be of optimal benefit, the exercise programs should be tailored to fit the abilities and pleasure of the individual.
Emotional factor3 Emotional factors are of considerable impor483
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tance in the quality of life during aging. They were not included in Belloc’s report, but they are significant in relation to health. Denes (141, in Hungary, studied the “old age emotions” of 100 persons in the 60-94 age group. The chief factors leading to emotional sterility were loneliness, retirement, and a decrease in sensory and locomotory functions. Among the 100 subjects, 60 were optimists and 40 were pessimists, and most of the pessimists were lonely. Humor A sense of humor is most important. One of the patients recently studied by us, an 84-yearold woman whose previously heavy breasts had shrunk to a mere shell, described her breasts as “basset hound ears.” Braceland (151, a senior consultant to the Institute of Living a t Hartford, Connecticut, wrote in his personal reflections on growing older, several things that helped him to age gracefully (and should help us in the same fashion): “I’ve passed another hurdle-I’m 75 and I’m starting on the last quarter. This time they tell me that when the coach takes you out, they don’t bench you-they plant you! As a precaution, therefore, when I put an envelope in the Sunday collection basket now, it is not a contribution - it is an investment. I’m anxious, of course, to end up in heaven, but I’m holding back, waiting for a lower entrance requirement. “I think I have recorded several times the fact that for years, in the still of the night, I could hear the cells dropping out of my cortex and drowning in the excess fluid in the widened sulci; I would hear them going down for the third time and it kept me awake. Well, that’s all over now-I don’t hear them any more. The cells apparently are all gone; I’m working on white matter, now gristle, and I’m on what the bankers and economists call the bottom line. “I will admit that my memory is not what it used to be. I have to fish for words, and my thingamabob, which used to contain thousands of words, has contracted a bit. I find I have to use roundabout methods to cover up. For instance, yesterday, I forgot the word ‘key’ and had to quickly make up a sentence about opening the door. I signed up for a memory course in town, and on coming out, I couldn’t remember where I had parked my car; by the second lesson I had forgotten where the place was, so I had to quit. Every year it seems the FDA makes the drug
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companies recall more, and I recall less. “I thought by this time I would have found the answers to some of the questions that have bugged me through the years and believed that for a while that I had, but now, unfortunately, I’ve even forgotten the questions. I have reached the age now when I have to put on my glasses and slippers and sit down in order to think. I have three pairs of glasses; one for distance, one for close-up work, and one to help me find the other two. It’s when I find them and can’t remember why I wanted them that I get upset. I rest on my laurels and, incidentally, that part of my anatomy has gotten broader even as my mind has gotten narrower. “I know I was getting old; recently when I looked at a picture of a horse for five minutes I missed the fact that Lady Godiva was on it. By the way, do you remember what Lord Godiva said on that occasion? He said, ‘I’ve got a bundle riding on that horse.’ Funny, I remember this historical things when I can’t remember what I had for breakfast.” Retirement Retirement also has an effect on the quality of life. Most studies on happy longevity indicate the importance of physical and mental activities. Many such articles point out the disadvantage of early retirement for many persons. Page (16) stated that a nationwide survey showed that more than three-fourths of those listed in “American Men and Women of Science” were interested in continuing scientific work after mandatory retirement; 40 percent of those over 81 were working. Others have reported that the United States has not been prepared for the retirement boom, and we are certainly unprepared for the growing number of people over age 65. Years ago there were seven working people for every retired person. Today that ratio has decreased to only two or three working people who are supporting one retiree. Individuals who no longer have a necessary role in the social and economic life of their society can deteriorate very rapidly. Retirement is a fertile field for the distortion of emotional life. It also seems that there is an unexpected increase in physical illness among retirees at any early age. Sex The quality of life in advancing age is frequently intertwined with sexual activity. In
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most societies the combination of males boasting of sexual prowess and the taboos against discussing the subject has made it difficult to collect reliable information about sexual activity in the elderly. We do know that sexual activity need not cease. Benjamin Franklin was a very busy man in many ways. He had a sense of humor and he appreciated the value of sex. He also recognized that in the aging population, the women outnumbered the men. In his “Old Mistresses Apol o p e , ” Franklin (17) suggested what may become a solution to the statistical imbalance of women versus men in the older population. In essence, he felt the older women and young men are ideally suited for one another. Many of these arguments would brand him as a male chauvinist in today’s world, but he numerated eight reasons why old women make good lovers. First, because as they (older women) have more knowledge of the world and their minds are better stored with observations. Their conversation is more improving and more lastingly agreeable. Second, because when women cease to be handsome, they study to be good. To maintain their influence over men, they supply the diminution of beauty by an augumentation of utility. They learn to do a thousand services, small and great, and are the most tender and useful of all friends when you are sick, thus they continue amiable, and hence there is hardly such a thing to be found as an old woman who is not a good woman. Third, because there is no hazard of children, which irregularly produced, may be attended with much inconvenience. Fourth, because through more experience they are more prudent and discreet in conducting a n intrigue to prevent suspicion. The commerce with them is therefore safer with regard to your reputation; and with regard to theirs, if the affair should happen to be known, considerate people might be rather inclined to excuse an old woman who would kindly take care of a young man, form his manners by her good counsels, and prevent his ruining his health and fortune among mercenary prostitutes. Fifth, because in every animal that walks upright, the deficiency of fluids that fill the muscles appears first in the highest part: the face first grows lank and wrinkled; then the neck, breasts and arms; the lower parts continuing to the last as plump as ever: so that covering all above with a basket, and regarding only what is below the girdle, it iq impossible of two women to know an old from a young one, and as in the dark all cats are grey, the pleasure of corporal
enjoyment with an old women is at least equal, and frequently superior, every knack being by practice capable of improvement. Sixth, because the sin is less. The debauching of a virgin may be her ruin, and make her for life unhappy. Seventh, because the compunction is less. The having made a young girl miserable may give you frequent bitter reflections, none of which can attend the making of an old woman happy. Eighth and lastly. They are so grateful!! Thomas Parr was famous in many countries. The Austrian literature reported that he was accused of having committed a sexual offense in his 102nd year, for which he was found guilty and punished. The following is the report (2) on his postmortem examination: “Of the postmortem examinations which have been recorded (they are unfortunately but few), the first and best known, so far as I am aware, is that of Thomas Parr, aged 152 years and 9 months, made by Dr. William Harvey, famous for his discoveries respecting the circulation of the blood, by command of the King (Charles I). The body was muscular, the chest and forearms hairy, the hair still being black, but the legs without hair. Organs of generation healthy; penis not retracted or extenuated; testes sound and large [so that it seemed not improbable that the common report was true, namely that he did public penitence, under a conviction for incontinence, after he had passed his 100th year; and his wife, whom he had married in his 120th year, did not deny that he had intercourse with her, after the manner of other husbands with their wives.] The chest was broad and ample; the lungs, nowise fungous, adhered, especially on the right side, to the ribs; heart large, thick and fibrous, with considerable quantity of fat; cartilages of ribs soft and flexible; stomach and intestines and all of the viscera sound; kidneys healthy, with the exception of a few watery cysts; no appearance of stone in them or in the bladder; spleen very small, scarcely equalling one of the kidneys; a good deal of fat about the mesentery, omentum and kidneys; brain healthy, firm and hard to the touch.” At the turn of the century healthy sex organs were considered essential to a long life. The elasticity of the thoracic cage and arcus senilis were considered important physical signs in evaluating aging. REVIEW OF PATIENTS As a result of our experiences and a review of
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the literature, we believe that the various health habits discussed are significant. We studied 52 patients over 80 years of age in some detail, to try to evaluate their state of health in relation to various factors including health habits. Although the 52 subjects were drawn a t random, they were limited to the group who could carry out the activities of daily living. We included the seven health habits studied by Belloc in addition to other habits considered to be significant. It is interesting that the 1889 study in the United Kingdom (2) involved longevity in relation to most of the same factors. Their study of 900 patients over age 80 was carried out by means of a questionnaire to doctors who were willing to respond. The following is a summary of our findings, and some comparisons with the findings in the United Kingdom report: Sleep. The sleep habits of most of the subjects were quite good. Almost all slept from 6-10 hours and very few used any sedation. The United Kingdom group showed similar characteristics regarding sleep. Nutrition. Most of the subjects were of normal weight, or thin. In the United Kingdom the terms “spare, average and fat” were used and in their group there were 114 spare, 182 normal and 37 fat people in the 80-90 group; in the 90-100 group, 99 were either normal or thin and 10 were fat. We did not have any truly obese persons in our study. Smoking is probably a more important health habit than some of the ones mentioned previously. In our group of 52 subjects, 47 were nonsmokers and only one was a heavy smoker. There was no comparable material in the United Kingdom study except in the 100+ group; of 45 who reported, 7 smoked a great deal, and 4 of these were women; 32 did not smoke; 5, including one woman, used snuff. Ph.ysica1 actiuit.y. Most of our oldsters were active, and 40 of the 52 were active both physically and mentally. Twelve were inactive, chiefly because of disabling arthritis or cardiovascular disease. In this group was a 90-year-old man who for 50 years played (walked) 18 holes of golf three times a week and continues to do so! Another man was very active in throwing a baseball, until the age of 90. One woman skied until she was more than 80 years old. Alcohol. In our group there were no heavy partakers of alcohol; 21 were abstainers. In the United Kingdom group, 20 of about 400 who were heavy drinkers, lived past the age of 80. One
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woman drank so much that she was locked up 200 times. Her father died of alcoholism (a drunk) a t age 90. There are always exceptions to any rule. We are always hearing of the centenarian who drinks and smokes. Lorand (1) from Austria reported this colorful exception: “A strong point against the anti-alcohol faddists is the case of Brown, an Irish peasant, who after many years of heavy beer drinking, attained the age of 120. His tombstone exhibits the following epitaph: ‘Here lies Brown, who became 120 only through the strong beer he was drinking. He was constantly drunk, and in this condition so terrible, that even death was afraid of him. When, however, one day contrary to his habits he was sober and in a quiet mood, death got courage, seized him, and thus a t last was triumphant.’ ” Heredity is significant. For all but one of the subjects in our study, the parents lived past the age of 70. Retirement. We were not able to determine either harmful or beneficial effects from retirement, although it is well known that retirement does have a negative effect in some instances. Most of our group led active lives after retirement. Blood pressure. Among the 52 subjects, 19 had a n elevated blood pressure, but only five had significant hypertension. We could make no comparisons with the United Kingdom 1899 study because blood pressure was not routinely measured a t that time. Laboratory findings did not conform to any significant pattern. Only two of the subjects had a high serum cholesterol level, and uric acid values usually were normal. The blood glucose findings did not indicate diabetes. Emotions. The emotional aspect was important in relation to the quality of health in our group. Five subjects were classified by us and our other observers as depressed or pessimistic; 46 were considered to be happy, with an optimistic outlook on life. Major illnesses. Some studies have shown that a major illness in the aged often is followed by death within a year. This did not happen in our group. Tables 1 and 2 show the major medical illnesses that occurred in patients past the age of 60. The results indicate that those who live to be 80 are probably more rugged and survive serious illnesses. Multiple problems. One of the important aspects of geriatrics is the number of concomitant diseases found in old people. Table 3 shows the
HEALTH HABITS IN RELATION TO AGING
Noveniher 1978
-
TABLE 1 Mujor Mcdiccil Illnesses in Patients Past Age 60 -~ ~~~
~
~~
~
~~~~~
~
Illness ~-
~
~~
~~
~~
-
Age of Patients (yrs.) ~
~
~
68 76 80 & 84 83 & 90 80, 84 & 85 79 77, 79, 81, 87 66 81 83 & 89
.-
TABLE 2 Mqlor Surgical Procedures in Patients Past Age 60
_ _ Age of Patients (yrs.)
~~~
Surgical Procedure _. -~
Nephrectomy Colon resection (colon CAI Aortic aneurysm resection Small-bowel resection Hysterectomy Cholecystectomy Cystocele Fractured hip Appendectomy Perineal repair Cataract Thyroidectomy Laryngeal neoplasm Prostate Slipped disc repair Dilatation & curettage Partial gastrectomy Bunionectomy _. ~. .~
No. of Patients 12 9 12 6 8 2 2
~~
Anesthetics (1 a t age 96) 35 patients Multiple illnesses 6 patients Many emotional crises over sudden deaths of spouses or children
~
No. of Drugs
-~
Carcinoma stomach Carcinoma endometrium Robbedandbeaten Herpes zoster Pulmonary embolus Myocardial infarction Transient ischemic attacks Subacute bacterial endocarditis Carcinoma cervix Cardiovascular accident
-~
TABLE 4 Numher of Drugs (incl. Over-the Counter) Taken h,y the 52 Patients 0 1 2 3 4 5
7 8 ~
~
~
1 ~~~
~
~
~
~
lenol (acetaminophen)I. Physical findings. Many of the findings on physical examination could not be adequately included in this study. Several physical changes that are not life-threatening can interfere with the quality of life. Of special significance is the decrease in sensation. This involves decreases in vision, hearing, taste, smell, thirst, and touch. Such changes can affect nutrition.
~
65 80 69 80 & 81 66, 69, 77, & 76 57, 66 & 66 84 80, 81, 83, 86, 87 & 94 74 76 & 84 71, 73, 87 75 & 79 77 76, 81, 84 & 98 77 70 66 66
TABLE 3 Number of Diagnoses in 52 Patients over 80 Years of Age Diagnosis
Number
Cardiovascular Gastroinestinal Genitourinary Skeletal Eye and ear Miscellaneous Total
120 79 34 57 41 62 393
diagnoses in our group. For the 52 subjects there were 393 diagnoses, i.e., an average of 7+ significant illnesses per patient. Drugs. Table 4 shows the numerical distribution of the drugs (including over-the-counter items) taken by the patients. It is encouraging that there was an average of only two drugs per patient, and only three patients were taking more than four drugs [including aspirin or Ty-
COMMENT
A profile of our healthy subjects over age 80 would be similar to that observed in the 1889 study in the United Kingdom. In any longitudinal study related to health habits, the effects of sensation on health and the effects of health habits should be examined in detail. The factors evaluated in this study did not necessitate elaborate or expensive equipment. The average physician in his office can use the information related to health habits to educate his patients. There are many health habits that influence the quality and the length of life, e.g., heredity, physical and mental status, and physiologic changes. Most of our over-80 subjects were of average weight or thin, and had good sleep patterns. They were active mentally and physically. Most of them did not smoke and used alcohol sparingly. Almost all were cheerful, optimistic, and had a good sense of humor. Further study on the effect of health habits on aging is indicated. REFERENCES 1. Lorand A: Old Age Deferred. Philadelphia, FA Davis, 1911. 2. Humphrey GM: Old Age. Cambridge, Macmillan and Bowes, 1889. 3. Granick S and Patterson RD: Human aging. 11, U. S. Dept. Health, Education, and Welfare, Public Health Service, Rockville, Maryland, 1976. 4. Busse EW and Pfeiffer E: Behavior and Adaptation in Late Life. Boston; Little, Brown & Co, 1977.
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5. Eichorn DH: The Berkeley longitudinal studies:continuities and correlates of behavior, Canad J Behavioral Sci 5: 298, 1973. 6. Shock N: Baltimore Longitudinal Study of Aging. Baltimore City Hospitals, Baltimore, MD. 7. Belloc NB: Relationship of health practices and mortality. Preventive Med 2: 67, 1973. 8. Leaf A: Life a n d Death and Medicine. ( A Scientific American book.) San Francisco, WH Freeman & Co, 1973, pp 29-36. 9. Cruikshank NH: Commentary on care of t h e elder1y:meeting t h e challenge of dependency, in Proceedings of a Conference at National Academy of Sciences, Washington, DC, May 17-19, 1976. New York, Academic Press, 1977. 10. Stare FJ: Three score and ten plus more, J Am Geriatrics SOC, 25: 529, 1977.
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11. McCay CM and Crowell MF: Effect of retarded growth upon length of life span and upon ultimate body size, J Nutrition 10: 63, 1935. 12. Hodgson J L and Buskirk ER: Physical fitne J Am Geriatrics SOC 25: 385, 1977. 13. Beverley E V The mechanics of putting those little-used muscles in motion, Geriatrics 31: 132, 1976. 14. Denes Z: Old-age emotions, J Am Geriatrics SOC 24: 465, 1976. 15. Braceland FJ: Personal reflections on growing older, The Critic 35 (3):66, (Spring) 1977. 16. Page IH: Must a n abundance of forms mean a n absence of contentment? (Editorial), Mod Medicine 44: 8, 1976. 17. Franklin B: Old Mistresses Apologue, in Literature of t h e Early Republic (2nd edition), ed. by E H Cady. New York; Holt, Rinehart and Winston, Inc. 1969, pp 404406.
