EDITORIAL Psychosomatic Medicine and Aging Research ROBERT N . BUTLER, MD AND BERNARD T. ENGEL, PHD*
On May 31, 1974, President Ford signed Public Law 93-296 which created the National Institute on Aging (NIA) as the eleventh National Institute of Health. With this Congressional mandate, the Secretary of HEW was directed to "develop a plan for a research program on aging designed to coordinate and promote research into biological, medical, psychological, social, educational, and economic aspects of aging." The new NIA was charged with the responsibility of formulating the HEW-wide research plan (which was completed and submitted to the Congress in December 1976) (1) and implementing select aspects of the program. Thus, NIA became the only Institute among the National Institutes of Health which was charged with the support of research on the psychological and social aspects of biomedical problems—the National Institute of Mental Health having attained bureau status and separated from NIH in 1967. The language of NIA's mandate is especially relevant to members of the American Psychosomatic Society and shows the great overlap between the research and clinical interests of NIA and those of APS. In part, this common ground derives from the fact that gerontology—the scientific study of the aging process—is one of the few fields of biology where it is widely accepted that mental and physical processes are inseparable. Investigators who have struggled with the dualistic mind/body arguments, and who have reached the monistic position described by Kimball (2) will find this point of view refreshing. In addition, gerontology is one of the few fields of biology in which it is recognized that it is essential to study disease as a developmental process and not merely as an acute event or an end-state. This is due to several factors. First of all, most of the diseases of late adult life are chronic diseases. The insidious onset and progressive development of such diseases as hypertension, arthritis, osteoporosis, and senile dementia, for example, are not amenable to the standard approach used in much medical research and treatment. Then too, aging is generally conceptualized as multifactorial rather than as a single process. Different physiological systems are known to age at different rates and the interaction among these systems reflects important individual differences (3). The current level of effort in gerontological research has done much to elucidate the marked changes in somatic processes that occur with age. To cite a few examples, the aging process is now associated with altered hormonal responsiveness (4), a change in neurotransmitter activity in certain brain *From the National Institute on Aging, NIH, Bethesda, MD 20014. Received for publication July 3,1978. Psychosomatic Medicine Vol. 40, No. 5 (August 1978) Copyright" 1978 by the American Psychosomatic Society, Inc. Published by Elsevier North-Holland, Inc.
365 0033-3174/7B/05036503$01.75
EDITORIAL
structures (5), and a progressive decline in immunocompetence (6). Of these, the last poses the most serious threat to the health and well-being of the elderly: an immunologically incompetent individual is highly susceptible to a variety of noxious environmental agents, including viruses, bacteria, rickettsia and allergens, and possibly even cancer. What we do not yet understand are the precise mechanisms controlling these changes—or the role of behavior in their natural history. Clearly much remains to be done. At the same time, investigations employing longitudinal methods of analysis indicate that learning, memory, reaction time, and problem-solving ability decline very late in life (7-9) even among educated, relatively healthy persons. We have yet to learn why some individuals never suffer losses in these abilities even in very old age, and how these behavioral processes are related to, and perhaps affected by, physiological and biological changes. The most useful mechanism for increasing our understanding of the normal aging process—and one which is most likely to help us quantify the interplay of somatic and behavioral factors in the causation of diseases—is the longitudinal study. One of the primary resources of the NIA Intramural Research Program is the 20-year-old Baltimore Longitudinal Study of the normal aging process. This study gives NIA researchers the opportunity to quantify types and rates of change over time with the hope of identifying those factors which determine health as well as disease. This is done by employing longitudinal analysis in conjunction with cross-sectional, cross-sequential, and time-sequential methods to weed out the biases entailed in repeating the measure with the same individuals, and also to separate cultural effects from age-related ones. Longitudinal studies also offer aging researchers opportunities to study stress and coping as individuals encounter the crises of adult life—retirement, bereavement, and widowhood are a few prominent examples—and, on a more general level, to test some of the cherished models of "normal" adult development. For example, is human development continuous as Erikson and others have proposed, or are the late years of life static and "declining" as some of the popular literature imply. Is early development critical in determining adjustments to late life, and if so, can we identify the factors which will predict how people will cope with various crises of later life and thereby mollify such crises? It is well known that the demographic profile of the American population is shifting as more and more persons survive into old age. In fact, it is projected that as many as 23 % of the American population will be 65 years or older in the year 2030 and that these people will have a life expectancy in excess of ten years. Are the psychological models and clinical skills now available adequate to deal with the medical and psychological problems that such a population shift will create? Are we properly training our students to provide sensitive care and effective treatment to the patients they will be serving? Throughout the forty or so years that APS has existed, the leading theorists in die field have argued that disease is multifactorial, that life is a continuous process and that current adjustments to life events must be understood in 366
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relation to past experiences. The time is rapidly approaching when these models will be put to the test and the National Institute on Aging intends to support the clinical and basic research and research training that will provide the answers.
REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9.
National Institute on Aging: Our Future Selves: A Research Plan Toward Understanding Aging. DHEW Publication No. 77-1096 Kimball CP: Conceptual developments in psychosomatic medicine: 1933-1969. Ann Intern Med 73: 307-316,1970 Frolkis VV: Aging of the autonomic nervous system, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 9 Adelman RC: Age-dependent effects in enzyme induction—a biochemical expression of aging. Exp Geront6: 75,1971 Finch Caleb E: Neuroendocrine and autonomic aspects of aging, in Finch CE and Hayflick L (eds.), Handbook of the Biology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 11 Makinodan T, Perkins EH, Chen MG: Immunologic activity of the aged. Advan Geront Res 3: 171-198, 1971 Craik FIM: Age differences in human memory, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 17 Arenberg DA, Robertson-Tchabo EA: Learning and aging, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 18 Welford AT: Motor performance, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 19
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On May 31, 1974, President Ford signed Public Law 93-296 which created the National Institute on Aging (NIA) as the eleventh National Institute of Health. With this Congressional mandate, the Secretary of HEW was directed to "develop a plan for a research program on aging designed to coordinate and promote research into biological, medical, psychological, social, educational, and economic aspects of aging." The new NIA was charged with the responsibility of formulating the HEW-wide research plan (which was completed and submitted to the Congress in December 1976) (1) and implementing select aspects of the program. Thus, NIA became the only Institute among the National Institutes of Health which was charged with the support of research on the psychological and social aspects of biomedical problems—the National Institute of Mental Health having attained bureau status and separated from NIH in 1967. The language of NIA's mandate is especially relevant to members of the American Psychosomatic Society and shows the great overlap between the research and clinical interests of NIA and those of APS. In part, this common ground derives from the fact that gerontology—the scientific study of the aging process—is one of the few fields of biology where it is widely accepted that mental and physical processes are inseparable. Investigators who have struggled with the dualistic mind/body arguments, and who have reached the monistic position described by Kimball (2) will find this point of view refreshing. In addition, gerontology is one of the few fields of biology in which it is recognized that it is essential to study disease as a developmental process and not merely as an acute event or an end-state. This is due to several factors. First of all, most of the diseases of late adult life are chronic diseases. The insidious onset and progressive development of such diseases as hypertension, arthritis, osteoporosis, and senile dementia, for example, are not amenable to the standard approach used in much medical research and treatment. Then too, aging is generally conceptualized as multifactorial rather than as a single process. Different physiological systems are known to age at different rates and the interaction among these systems reflects important individual differences (3). The current level of effort in gerontological research has done much to elucidate the marked changes in somatic processes that occur with age. To cite a few examples, the aging process is now associated with altered hormonal responsiveness (4), a change in neurotransmitter activity in certain brain *From the National Institute on Aging, NIH, Bethesda, MD 20014. Received for publication July 3,1978. Psychosomatic Medicine Vol. 40, No. 5 (August 1978) Copyright" 1978 by the American Psychosomatic Society, Inc. Published by Elsevier North-Holland, Inc.
365 0033-3174/7B/05036503$01.75
EDITORIAL
structures (5), and a progressive decline in immunocompetence (6). Of these, the last poses the most serious threat to the health and well-being of the elderly: an immunologically incompetent individual is highly susceptible to a variety of noxious environmental agents, including viruses, bacteria, rickettsia and allergens, and possibly even cancer. What we do not yet understand are the precise mechanisms controlling these changes—or the role of behavior in their natural history. Clearly much remains to be done. At the same time, investigations employing longitudinal methods of analysis indicate that learning, memory, reaction time, and problem-solving ability decline very late in life (7-9) even among educated, relatively healthy persons. We have yet to learn why some individuals never suffer losses in these abilities even in very old age, and how these behavioral processes are related to, and perhaps affected by, physiological and biological changes. The most useful mechanism for increasing our understanding of the normal aging process—and one which is most likely to help us quantify the interplay of somatic and behavioral factors in the causation of diseases—is the longitudinal study. One of the primary resources of the NIA Intramural Research Program is the 20-year-old Baltimore Longitudinal Study of the normal aging process. This study gives NIA researchers the opportunity to quantify types and rates of change over time with the hope of identifying those factors which determine health as well as disease. This is done by employing longitudinal analysis in conjunction with cross-sectional, cross-sequential, and time-sequential methods to weed out the biases entailed in repeating the measure with the same individuals, and also to separate cultural effects from age-related ones. Longitudinal studies also offer aging researchers opportunities to study stress and coping as individuals encounter the crises of adult life—retirement, bereavement, and widowhood are a few prominent examples—and, on a more general level, to test some of the cherished models of "normal" adult development. For example, is human development continuous as Erikson and others have proposed, or are the late years of life static and "declining" as some of the popular literature imply. Is early development critical in determining adjustments to late life, and if so, can we identify the factors which will predict how people will cope with various crises of later life and thereby mollify such crises? It is well known that the demographic profile of the American population is shifting as more and more persons survive into old age. In fact, it is projected that as many as 23 % of the American population will be 65 years or older in the year 2030 and that these people will have a life expectancy in excess of ten years. Are the psychological models and clinical skills now available adequate to deal with the medical and psychological problems that such a population shift will create? Are we properly training our students to provide sensitive care and effective treatment to the patients they will be serving? Throughout the forty or so years that APS has existed, the leading theorists in die field have argued that disease is multifactorial, that life is a continuous process and that current adjustments to life events must be understood in 366
Psychosomatic Medicine Vol. 40, No. 5 (August 1978)
EDITORIAL
relation to past experiences. The time is rapidly approaching when these models will be put to the test and the National Institute on Aging intends to support the clinical and basic research and research training that will provide the answers.
REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9.
National Institute on Aging: Our Future Selves: A Research Plan Toward Understanding Aging. DHEW Publication No. 77-1096 Kimball CP: Conceptual developments in psychosomatic medicine: 1933-1969. Ann Intern Med 73: 307-316,1970 Frolkis VV: Aging of the autonomic nervous system, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 9 Adelman RC: Age-dependent effects in enzyme induction—a biochemical expression of aging. Exp Geront6: 75,1971 Finch Caleb E: Neuroendocrine and autonomic aspects of aging, in Finch CE and Hayflick L (eds.), Handbook of the Biology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 11 Makinodan T, Perkins EH, Chen MG: Immunologic activity of the aged. Advan Geront Res 3: 171-198, 1971 Craik FIM: Age differences in human memory, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 17 Arenberg DA, Robertson-Tchabo EA: Learning and aging, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 18 Welford AT: Motor performance, in Birren JE and Schaie KW (eds.), Handbook of the Psychology of Aging. New York: Van Nostrand Reinhold Co., 1977, Chap. 19
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