Tagged Age, Chronological

The Covid Balancing Act for Doctors

Doctors

The Covid Balancing Act

At the start of the pandemic, I was “Dr. No” to my in-laws and cancer patients, but my conversations have become more nuanced.

Credit…Getty Images

  • Jan. 7, 2021, 5:00 a.m. ET

My wife’s parents have led a relatively monastic existence since about mid-March.

Both are in their 80s and live independently in rural Pennsylvania, maintaining a three-acre property by themselves. My father-in-law, the older of the two, has skirted major medical problems despite a decades-long indiscriminate diet, a testimony to the triumph of genetics over lifestyle choices. My mother-in-law, on the other hand, has been ravaged by lupus, which flares regularly and requires medications that suppress her immune system.

So when Covid-19 hit, we feared for their health, given their ages and her compromised immunity, and begged that they place themselves on lockdown, so we wouldn’t lose them to the pandemic.

And they did.

Where they used to buy groceries at their local Giant Eagle supermarket (which they call the “Big Bird,”) they turned instead to Instacart for home delivery, shrugging off the random items their shopper would get wrong with good humor.

Where they used to attend church in person every Sunday, they caught the video highlights online when they became available on Monday morning.

We arranged weekly Zoom calls with them, to replace our frequent visits.

We used to say that their social life rivaled ours, as they got together with friends they have known since kindergarten (kindergarten!) several times each week for dinner, drinks or shows. Instead, during the pandemic, they’ve replaced those social events with going cruising together in their blue ’55 Chevy Bel Air, satisfying themselves with the feel of a car they first drove in their teens, the beautiful countryside and a wave at their friends, who sat at a safe distance on their front porches.

Our whole family has been proud of them to the point of bursting. But in September, after six months of this, my father-in-law got antsy and did the unthinkable: He went to the hardware store, ostensibly for a tool, but really to see his friends who tend to congregate there.

He caught hell for his modest indiscretion, first from his wife, and then from mine. They explained to him that he could have ordered the piece online. They reminded him that his actions can affect my mother-in-law, and her frail health, too. Finally, he had enough.

“I’m 85 years old,” he said. “Eighty-five! I’m careful, I wore a mask. What do you expect me to do, spend the rest of my days here in prison?”

That gave me pause — my wife, too. At 85, he had done the math. Despite his lucky genetics, he probably didn’t have many years left on this earth, and he didn’t want to spend one or two of them in isolation.

Understanding the risks and consequences of his actions, shouldn’t he be allowed to see his buddies at the hardware store, and maybe buy a tool while he’s there?

I thought about it from the perspective of my patients, many of whom also don’t have much time left on this earth, and the conversations we had been having in clinic.

At the beginning of the pandemic, I was “Dr. No,” prohibiting my patients, most of whom have devastated immune systems, from engaging in their usual social activities. Where much of what we had all been hearing from government authorities about Covid-19 transmission had often been contradictory, I wanted to give concrete advice.

Attending a family gathering to celebrate a birthday? No.

How about a high school graduation party for a granddaughter? No.

Visiting elderly parents in another state? Not safe for you or them.

A road trip to Montana with a friend (this from a man in his 80s with leukemia): Are you kidding me?

At the risk of sounding paternalistic, I feared for my patients’ health, as I did for my in-laws’ health, and wanted to protect them.

But perhaps because our understanding of Covid-19’s epidemiology has gotten better over time; or with our recognition that we may have to live with the pandemic for many months more; or given my father-in-law’s perspective that people at the end of life should make their own risk-benefit calculations, my conversations have now become more nuanced.

I’m more open to my patients not missing important life events, when there may not be much life for them left, provided they take precautions to avoid endangering themselves or those around them, particularly amid the most recent surge in Covid-19 cases.

One woman with leukemia was receiving chemotherapy early in 2020 when her daughter had a miscarriage. Now that her daughter is eight months pregnant again, can she hold the baby when it is born? Absolutely, let’s talk about how to do it safely.

Another patient’s mother died. Can she attend the funeral? Yes, with appropriate distancing, limited numbers, and personal protective equipment. But skip the reception.

The road trip to Montana? I still wasn’t comfortable with that, but my patient and his friend went anyway, took their own food, slept in their truck, and he returned without Covid-19.

And my father-in-law? He gets out of the house a little bit more than he used to, but not as much as he’d like. The rare times that he does nowadays, he is always masked and stays outdoors, and both he and my mother-in-law remain Covid-19-free.

Which strikes me as about the right balance.

Mikkael Sekeres (@mikkaelsekeres) is the chief of the Division of Hematology, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and author of When Blood Breaks Down: Life Lessons from Leukemia.”

Weekly Health Quiz: A New Coronavirus Variant, Diet Guidelines and Really Short Workouts

1 of 7

The first case of a highly contagious coronavirus variant originally discovered in Britain was found in the United States, detected in a young man living in this state:

Alabama

California

Colorado

Florida

2 of 7

This state became the first to surpass two million coronavirus cases:

Texas

California

New York

Florida

3 of 7

Middle-aged and older adults saw marked improvements in fitness and strength after performing intense exercise intervals on a stationary bike for periods as short as:

4 seconds

40 seconds

4 minutes

40 minutes

4 of 7

Experts warn that doctors too often prescribe these risky medications to treat sinus and respiratory infections, even though evidence that they provide any benefit is lacking:

Opiates

Blood thinners

Steroid shots or pills

Antibitoics

5 of 7

The newly released Dietary Guidelines for Americans include which of the following changes?

Cutting added sugars in the diet from 10 percent of daily calories to 6 percent of daily calories

Limiting the amount of alcohol men should consume to one drink a day, a decrease from two drinks a day

Avoiding added sugars altogether for children under 2

All of the above

6 of 7

Suicide rates are highest in this group:

White Americans

Black Americans

Hispanics

Asian-Americans

7 of 7

Which statement about hereditary angioedema, or HAE, is true?

It is a rare, inherited disorder that often causes swelling of the face, hands or feet

Painul swelling can also affect the gastrointestinal or respiratory tracts, with sometimes deadly consequences

A pregnancy or starting birth control pills can set off attacks of HAE

All of the above

Don’t Let the Pandemic Stop Your Shots

the new old age

Don’t Let the Pandemic Stop Your Shots

Even as older adults await the coronavirus vaccine, many are skipping the standard ones. That’s not wise, health experts say.

Credit…Chris Lyons

  • Dec. 28, 2020, 12:12 p.m. ET

Peggy Stein, 68, a retired teacher in Berkeley, Calif., skipped a flu shot this year. Her reasoning: “How could I get the flu if I’m being so incredibly careful because of Covid?”

Karen Freeman, 74, keeps meaning to be vaccinated against shingles, but hasn’t done so. A retired college administrator in St. Louis, she quipped that “denial has worked well for me these many years.”

Sheila Blais, who lives on a farm in West Hebron, N.Y., has never received any adult vaccine. She also has never contracted the flu. “I’m such an introvert I barely leave the farm, so where’s my exposure?” said Ms. Blais, 66, a fiber artist. “If it’s not broke, don’t fix it.”

While older adults await vaccination against Covid-19, public health officials also worry about their forgoing, forgetting, fearing or simply not knowing about those other vaccines — the ones recommended for adults as we age and our immune systems weaken.

“There’s a lot of room for improvement,” said Dr. Ram Koppaka, associate director for adult immunization at the Centers for Disease Control and Prevention.

Every year, campaigns urge older adults to protect themselves against preventable infectious diseases. After all, influenza alone has killed 12,000 to 61,000 Americans annually over the past decade, most of them 65 or older, and has sent 140,000 to 810,000 people a year to hospitals.

The coronavirus pandemic has introduced another imperative. Those hospitals are filling fast with Covid-19 patients; in many places they are already swamped, their staffs overworked and exhausted.

“Knowing how stressed the health care system is, prevention is key,” said Dr. Nadine Rouphael, a vaccine researcher and infectious disease specialist at Emory University. “When we have record numbers of deaths, why would you go to a hospital for a vaccine-preventable illness?”

Yet the nation has long done a better job of vaccinating its children than its elders. The most recent statistics, from 2017, show that about one-third of adults over 65 had not received a flu shot within the past year. About 30 percent had not received the pneumococcus vaccine.

The proportion receiving the shingles vaccine, a fairly recent addition to the list, has inched up, but by 2018 only 34.5 percent of people over 60 had been vaccinated.

Moreover, Dr. Koppaka pointed out: “When you look deeper, there are longstanding, deep, significant differences in the proportion of Black and Hispanic adults getting vaccines compared to their white counterparts. It’s really unacceptable.”

Close to 40 percent of non-Hispanic whites had been vaccinated against shingles, for instance, compared with fewer than 20 percent of Blacks and Hispanics.

One might expect a group who can recall polio fears and outbreaks of whooping cough to be less hesitant to get vaccinated than younger cohorts. “You’ll probably have a different concept of vaccination from someone who never experienced what a serious viral illness can do,” Dr. Koppaka said.

When it comes to the Covid-19 vaccine, for instance, only 15 percent of those over 65 say they would definitely or probably not get it, compared with 36 percent of those 30 to 49, a Kaiser Family Foundation tracking poll showed earlier this month. (Ms. Stein, Ms. Blais and Ms. Freeman all said they would happily accept the Covid vaccine.)

But for other diseases, vaccination rates lag. Given that older people are more vulnerable to severe illness from them, why the gaps in coverage?

Internists and other doctors for adults don’t promote vaccines nearly as effectively as pediatricians do, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. Older patients, who often see a variety of doctors, may also have trouble keeping track of when they got which shot.

Experts fear that vaccination rates may have fallen further during the pandemic, as they have among children, if older people wary of going to doctors’ offices or pharmacies skipped shots.

Financial and bureaucratic obstacles also thwart vaccination efforts. Medicare Part B covers three vaccines completely: influenza, pneumococcus and, when indicated, hepatitis B.

The Tdap and shingles vaccines, however, are covered under Part D, which can complicate reimbursement for doctors; the vaccines are easier to obtain in pharmacies. Not all Medicare recipients buy Part D, and for those who do, coverage varies by plan and can include deductibles and co-pays.

Still, older adults can gain access to most recommended vaccines for no or low cost, through doctors’ offices, pharmacies, supermarkets and local health departments. For everyone’s benefit, they should.

Here’s what the C.D.C. recommends:

Influenza An annual shot in the fall — and it’s still not too late, because flu season peaks from late January into February. Depending on which strain is circulating, the vaccine (ask for the stronger versions for seniors) prevents 40 to 50 percent of cases; it also reduces illness severity for those infected.

Thus far this year, flu activity has remained extraordinarily low, perhaps because of social distancing and masks or because closed schools kept children from spreading it. Manufacturers shipped a record number of doses, so maybe more people got vaccinated. In any case, fears of a flu/Covid “twindemic” have not yet been realized.

Nevertheless, infectious disease experts urge older adults (and everyone over six months old) to get flu shots now. “Flu is fickle,” Dr. Schaffner said. “It could take off like a rocket in January.”

Tetanus, diphtheria, pertussis. A booster of TD vaccine every 10 years, to prevent tetanus and diphtheria. If you’ve never had the Tdap vaccine — which adds prevention against pertussis — that’s the one you want. Although pertussis, better known as whooping cough, occasionally shows up in adults, newborns are particularly at risk. Pregnant women will ask expectant grandparents to get a Tdap shot. Because it is covered under Part D, a pharmacy is the best bet.

Pneumococcus. “It’s a pneumonia vaccine, but it also prevents the most serious consequences of pneumonia, including meningitis and bloodstream infections,” Dr. Koppaka said.

People over 65 should get the polysaccharide formula — brand name Pneumovax — but there are certain circumstances, such as immune-compromising conditions, to discuss with a health care provider.

Those over 65 may choose, again in consultation with a provider, to also get the conjugate pneumococcal vaccine (brand name Prevnar), which provides some additional protection. If so, C.D.C. guidelines specify which vaccine to take when.

Shingles. Social distancing won’t ward off this disease; anyone who had chickenpox, which is just about every senior, still carries the virus.

“If you live to be 80, you stand a 35 to 50 percent chance of having an episode,” Dr. Schaffner said. “And the older you are when you get it, the more apt you are to get the most serious complication” — lingering nerve pain called post-herpetic neuralgia.

The C.D.C. recommends Shingrix, the highly effective shingles vaccine the F.D.A. approved in 2017, for everyone over 50. The previous shingles vaccine has been discontinued. Get Shingrix even if you had the earlier vaccine, Zostavax, and even if you’ve had shingles — it can recur.

The two required shots, given two to six months apart, can total $300 out of pocket. But Medicare Part D beneficiaries will pay an average of $50 for the pair, said a spokesman for the manufacturer GlaxoSmithKline, and people with private insurance even less.

Hepatitis A and hepatitis B. These aren’t age-related; the vaccines are recommended for people with certain health conditions, including chronic liver disease and H.I.V. infection, or for travelers to countries where the diseases are widespread.

The hepatitis B vaccine is also recommended, at a provider’s discretion, for diabetics over 60 who haven’t been previously vaccinated. Talk to a health care professional about your risks.

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Weekly Health Quiz: Body Fat, Pulse Oximeters and a New Strain of Coronavirus

1 of 7

Cold weather is hitting many parts of the country, posing challenges for social distancing during the pandemic. Which statement about acclimating to cold weather is not true?

People over 60 tend to be less tolerant of cold than younger people

Carrying extra body fat helps protect against cold

Heat loss tends to be greater in men than women

Being physically active helps protect against cold

2 of 7

A new variant of the novel coronavirus that is sweeping through the United Kingdom appears to be:

Far deadlier than existing strains

Resistant to current vaccines

More contagious than existing strains

All of the above

3 of 7

Pulse oximeters, which measure blood oxygen levels and can be a lifesaving tool for monitoring Covid-19 symptoms, may be less accurate in this group:

People who are sedentary

Athletes

Adults over 70

People with darker skin

4 of 7

A Norweigan study found that older men and women were less likely to die prematurely when they incorporated which of the following into their weekly workouts?

A moderate 50-minute walk

Strength training

Short bursts of intense exercise

All types of exercise showed a similar impact on longevity

5 of 7

Some localities are banning elective surgery because of rising coronavirus case counts. Elective surgery refers to surgery that is:

Optional

Not urgent

Performed in a non-hospital setting

All of the above

6 of 7

Prospective fathers with this medical condition were more likely to sire a pregnancy that did not reach full term:

Diabetes

Hypertension

Obesity

All of the above

7 of 7

Consumption of this beverage was tied to an increased risk of frailty in older women:

Coffee

Tea

Wine

Sugary or artificially sweetened drinks

Talking to Younger Men About Growing Old

Photo

For Robert Goldfarb, 85, resisting the decline of old age goes beyond the treadmill.

For Robert Goldfarb, 85, resisting the decline of old age goes beyond the treadmill.Credit

An electronic display on the treadmill in my local gym reminds me I’m not only running on the machine, but out of time. Its graph comparing changes in the runner’s heart rate to that of peers goes no further than age 70. I’m 85, and find it ominous that the machine presumes that anyone that old shouldn’t be on the thing.

Reminders that I’m now officially one of the old-old appear with greater frequency. Some are subtle, like the treadmill display; others are more jarring, like my daughter’s approaching 60th birthday. Most reminders are well-meaning: a young woman offering her seat on a bus, an airport employee hurrying over with a wheelchair, happily telling me I won’t have to walk to the gate or stand in line. I graciously decline their kindness, struggling not to protest, “But, I’m a competitive runner!” That I feel robust doesn’t matter; the man I see and the man they see are two very different people.

I recently read something the philosopher Montaigne wrote over 400 years ago: “The shorter my possession of life, the deeper and fuller I must make it.” His words inspired me to seek a path through old age without surrendering to it or ignoring its reality.

I began by fighting memory lapses. Rather than substituting “whatever” for an elusive word, I now strain to recall that word, even if means asking others to bear with me for a bit. I avoid phrases that suggest the end of things, like “downsizing” or “I no longer do that.” I subscribe to internet memory games. To recapture the excitement I felt in long-ago classrooms, I began rereading books I read in college.

I also decided to reach out to men my age to learn how they navigate through growing old. Like most of the men I began speaking with, I’m a product of the 1950s and its pressure to conform, to avoid risk, to shun anything that marked one as “different.” Many young people then were warned by parents that signing petitions bearing words like “protest” or “progressive” would get them rejected for a job or fired when they grew up. Men in my platoon didn’t embrace when we parted after serving in the Korean War. Closer than brothers, we settled for a handshake, knowing that’s what men did.

Almost immediately, I found conversations with men my age awkward. Attempts I made to discuss aging were met with jokes about the alternative. With few exceptions, those I spoke with regarded feelings as something to be endured, not discussed. It quickly became clear I was free to contemplate growing old, but not with them.

My wife suggested I meet with younger acquaintances to learn if they would talk with me about aging. I did, and found that men just 10 years younger spoke openly about changes in their minds and bodies. No one joked or changed the subject when one of them confided, “My father had Alzheimer’s, and I’m beginning to forget the same things he did,” or, “My firm’s managing partner said I was slowing younger associates and had to retire.”

It puzzled me that they felt so much freer to discuss feelings than men born just a decade earlier. Could it be because they were shaped by the ’60s, rather than the ’50s? Growing up, they protested what we accepted, challenged authority we obeyed, celebrated their individuality while we hoped to be one of the men in a gray flannel suit. They were the “me” generation, defined by Woodstock and rock ‘n’ roll, while my generation found comfort in Eisenhower’s paternal leadership and listening to soothing ballads like George Shearing’s “I’ll Remember April” and Margaret Whiting’s “Moonlight in Vermont.” Separated by a sliver of time, the two decades seem an eternity apart.

As I seek to reinvent myself, questioning what I do out of habit and what I’m not doing that could be liberating, it’s the voices of these younger men that I hear as I run on the treadmill today. That and the voice of Frank Sinatra from the ’50s, crooning a line from “September Song” that captures what I’ve been feeling: “But the days grow short when you reach September.” It’s realizing that I’ve reached November that presses me forward, ignoring the treadmill’s display, hoping I can lead a deeper and fuller life before I run out of time.

Robert W. Goldfarb is a management consultant and author of “What’s Stopping Me From Getting Ahead?”

At 100, Still Running for Her Life

Video

100 and She Just Won’t Stop

She is a national champion, a former activist and a centenarian. And she runs.

By NOAH REMNICK and ERICA BERENSTEIN on Publish Date April 22, 2016. Photo by Elias Jerel Williams for The New York Times.

On a cloudless Sunday afternoon in April, a 100-year-old woman named Ida Keeling laced up her mustard yellow sneakers and took to the track at the Fieldston School in the Bronx. Her arrival was met without fanfare. In fact, no one in the stands seemed to notice her at all.

It is possible the spectators were distracted by the girls’ soccer game taking place on the field. Or perhaps they were simply unaware that Ms. Keeling is a reigning national champion.

Photo

Ms. Keeling, 100, holds a record for the 60-meter dash for American women ages 95 to 99.

Ms. Keeling, 100, holds a record for the 60-meter dash for American women ages 95 to 99.Credit Elias Jerel Williams for The New York Times

When she runs, Ms. Keeling occupies a lane all her own. She has held several track-and-field records since she began racing in her late 60s, and she still has the fastest time for American women ages 95 to 99 in the 60-meter dash: 29.86 seconds. In the week to come, she plans to compete in a 100-meter event at the Penn Relays in Philadelphia, where she hopes to establish a new standard for women over 100 years old.

“You see so many older people just sitting around — well, that’s not me,” said Ms. Keeling, who is barely 4-foot-6 and weighs 83 pounds. “Time marches on, but I keep going.”

Ms. Keeling was not always such an accomplished runner. As a child growing up in Harlem, she preferred riding bikes or jumping rope. With Title IX half a century away, there were few opportunities for girls, let alone black girls, to play organized sports. When she did run, it was always to race, never to exercise.

“I was pretty fast as a girl,” she said. “What makes me faster now is that everyone else slowed down.”

When the Depression hit, Ms. Keeling’s athletic inclinations receded into memory, supplanted by a series of jobs washing windows and babysitting for neighbors. Her family, who for years lived in cramped quarters in the back of her father’s grocery, was forced into even more humbling circumstances when the store went out of business and her father began peddling fruits and vegetables from a pushcart for a living.

“I learned to stand on my own two feet during the Depression,” she said. “It taught you to do what you had to do without anyone doing it for you.”

Photo

Shelley Keeling, left, and her mother, Ida Keeling, on a balcony in the Riverdale section of the Bronx.

Shelley Keeling, left, and her mother, Ida Keeling, on a balcony in the Riverdale section of the Bronx.Credit Elias Jerel Williams for The New York Times

Ms. Keeling’s resilience only deepened with time. After her husband died of a heart attack at 42, she was left to raise their four children on her own. She moved the family into a one-bedroom apartment in a Harlem housing project and took up work sewing in a factory, all the while contending with the abuses and indignities endured by black women in mid-20th-century America. As the civil rights movement took shape, Ms. Keeling became an active demonstrator, shuttling her children to Malcolm X speeches and boarding a predawn bus for the 1963 March on Washington.

“I always understood from mother that you die on your feet rather than live on your knees,” said her daughter Shelley Keeling.

Over time, that resolve was gravely tested. While serving overseas in the Navy, Ms. Keeling’s older son, Donald, developed a crippling drug addiction that he struggled to shed even after returning home to Harlem. His habit ensnared his younger brother, Charles, who had served in the Army. Ms. Keeling watched in horror as both boys, barrel-chested charmers who friends joked looked like superheroes, withdrew into the world of drugs.

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Ms. Keeling stretched her legs in her daughter’s living room in the Bronx last month.

Ms. Keeling stretched her legs in her daughter’s living room in the Bronx last month.Credit Elias Jerel Williams for The New York Times

In 1978, Ms. Keeling received a call from the police informing her that Donald had been hanged. Around two years later, the phone rang again: Charles was dead — beaten in the street with a baseball bat. Both killings were suspected to be drug-related; neither was ever solved.

“I’ve never felt a pain so deep,” Ms. Keeling recalled, her voice lowering to a whisper. “I couldn’t make sense of any of it and things began to fall apart.”

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A stretch to improve Ms. Keeling’s blood flow and flexibility.

A stretch to improve Ms. Keeling’s blood flow and flexibility.Credit Elias Jerel Williams for The New York Times

As Ms. Keeling fell into a deep depression, her health began to falter. Her blood pressure shot up, along with her heart rate. The image of her once-vital mother in such despair shook the younger Ms. Keeling. A lifelong track-and-field athlete whose trophies fill an entire room of her apartment, she intervened with the means of healing most familiar to her: running.

“It was trial by fire,” recalled Shelley Keeling, 64, who has coached track and field at Fieldston for 21 years. “Based on where she was emotionally, it just had to be.”

After some coaxing from her daughter, Ms. Keeling, then 67, registered for a five-kilometer race through Brooklyn. It had been decades since she had last gone running. The two women took off together, but the younger Ms. Keeling soon darted to the front of the pack as her mother drifted far behind. After a suspenseful respite, was relieved to see her mother scamper across the finish line, barely out of breath.

“Good Lord, I thought that race was never going to end, but afterwards I felt free,” Ms. Keeling recalled. “I just threw off all of the bad memories, the aggravation, the stress.”

So began the sunset career of Ida Keeling, at a time when most of her peers were settling in for a future of seated yoga or abandoning athletics altogether. In the decades since, she has traveled across the world for competitions. She often races alone, the only contestant in her age group.

“Now I’m just chasing myself — there’s no one else to compete with,” she said. “It’s wonderful, but it feels a little crazy.”

Running gives Ms. Keeling a sense of serenity, she said. Her sinewy arms urge her body forward, each stride stronger than the last as she picks up momentum. Though she has developed arthritis and occasionally relies on a cane while walking, Ms. Keeling betrays none of her ailments as she runs.

To maintain her health, Ms. Keeling adheres to a stringent regimen of diet (“I eat for nutrition, not for taste”) and exercise (“I’ve got to get my hour in every day”). On a recent afternoon, Shelley Keeling led her mother through a routine that included push-ups, wall sits, shoulder presses and sprints back and forth on the balcony of her apartment in the Riverdale section of the Bronx. Ms. Keeling lives alone and says that self-sufficiency is a key to her longevity.

“I don’t beg nobody for nothing,” she said. “I wash, cook, iron, scrub, clean, mop and shop.”

Photo

Ms. Keeling exceeded the five push-ups that her daughter had asked of her.

Ms. Keeling exceeded the five push-ups that her daughter had asked of her.Credit Elias Jerel Williams for The New York Times

Ms. Keeling eschews food products with preservatives, favoring fresh grains and produce, along with limited portions of meat. Desserts are rarities, and a tablespoon of cod-liver oil supplements breakfast most mornings. Despite her exceptional discipline, Ms. Keeling allows herself one indulgence. “This is putting gas in the car,” she said before downing a tall shot of Hennessy.

There are days when Ms. Keeling battles a surge of arthritis or a hint of melancholy. “I never want to go backwards,” she said. “I’m a forward type of person.”

As she navigated the track at Fieldston, a nasty cramp shot up her right leg, hobbling her gait. For a moment she seemed to hesitate as she let out a deep sigh and slowed her pace. But then Ms. Keeling dispensed with the pain the only way she knew how. She ran through it.

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Exercise Makes Our Muscles Work Better With Age

Photo

Credit Getty Images

To keep our muscles healthy deep into retirement, we may need to start working out more now, according to a new study of world-class octogenarian athletes. The study found substantial differences at a cellular level between the athletes’ muscles and those of less active people.

Muscular health is, of course, essential for successful aging. As young adults, we generally have scads of robust muscle mass. But that situation doesn’t last.

Muscles consist of fibers, each attached to a motor neuron in our spinal column by long, skinny nerve threads called axons. The fiber and its neuron are known as a muscle unit.

When this muscle unit is intact, the neuron sends commands to the muscle fiber to contract. The muscle fiber responds, and your leg, eyelid, pinky finger or other body part moves.

However, motor neurons die as we age, beginning as early as in our 30s, abruptly marooning the attached muscle fiber, leaving it disconnected from the nervous system. In younger people, another neuron can come to the rescue, snaking out a new axon and re-attaching the fiber to the spinal cord

But with each passing decade, we have fewer motor neurons. So some muscle fibers, bereft of their original neuron, do not get another. These fibers wither and die and we lose muscle mass, becoming more frail. This process speeds up substantially once we reach age 60 or so.

Scientists have not known whether the decline in muscular health with age is inevitable or whether it might be slowed or altered.

There have been encouraging hints that exercise changes the trajectory of muscle aging. A 2010 study of recreational runners in their 60s, for instance, found that their leg muscles contained far more intact muscle units than the muscles of sedentary people of the same age.

But whether exercise would continue to protect muscles in people decades older than 60, for whom healthy muscles might be the difference between independence and institutionalization, had never been examined.

So for the new study, which was published last week in the Journal of Applied Physiology, researchers from McGill University in Canada and other schools contacted 29 world-class track and field athletes in their 80s and invited them to the university’s performance lab. They also recruited a separate group of healthy but relatively inactive people of the same age to act as controls.

At the lab, the scientists measured muscle size and then had the athletes and those in the control group complete a simple test of muscular strength and function in which they pressed their right foot against a movable platform as forcefully as possible. While they pressed, the scientists used sensors to track electrical activity within a leg muscle.

Using mathematical formulas involving muscle size and electrical activity, the scientists then determined precisely how many muscle units were alive and functioning in each volunteer’s leg muscle. They also examined the electrical signal plots to see how effectively each motor neuron was communicating with its attached muscle fiber.

Unsurprisingly, the elite masters athletes’ legs were much stronger than the legs of the other volunteers, by an average of about 25 percent. The athletes had about 14 percent more total muscle mass than the control group.

More interesting to the researchers, the athletes also had almost 30 percent more motor units in their leg muscle tissue, and these units were functioning better than those of people in the sedentary group. In the control group, many of the electrical messages from the motor neuron to the muscle showed signs of “jitter and jiggle,” which are actual scientific terms for signals that stutter and degrade before reaching the muscle fiber. Such weak signaling often indicates a motor neuron that is approaching death.

In essence, the sedentary elderly people had fewer motor units in their muscles, and more of the units that remained seemed to be feeling their age than in the athletes’ legs.

The athletes’ leg muscles were much healthier at the cellular level.

“They resembled the muscles of people decades younger,” said Geoffrey Power, who led the study while a graduate student at McGill and is now an assistant professor at the University of Guelph in Ontario.

Of course, this type of single-snapshot-in-time study can’t tell us whether the athletes’ training actually changed their muscle health over the years or if the athletes were somehow blessed from birth with better muscles, allowing them to become superb masters athletes.

But Dr. Power, who also led the 2010 study, said that he believes exercise does add to the numbers and improve the function of our muscle units as we grow older.

Whether we have to work out like a world-class 80-year-old athlete to benefit, however, remains in question. Most of these competitors train intensely for several hours every week, Dr. Power said. But on the plus side, some of them did not start their competitive regimens until they had reached their 50s, providing hope for the dilatory among us.

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