Tagged Elderly

Finding Ways to Keep Patients at Home

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Credit Getty Images

My patient was a proudly elegant woman in her 70s who lived alone. Her Parkinson’s disease had so severely restricted her ability to move that it would take her hours to get dressed in the morning. And leaving the house was virtually impossible, so she had to rely on neighbors and friends from her church community for help with shopping.

She was adamant that she wouldn’t want aggressive treatment to keep her alive. She’d been hospitalized many times, and she told me she wouldn’t want to take a hospital bed that would be better used for someone else. So she dutifully completed an advance directive that made her wishes clear. It said that she would not want to be kept alive on a breathing machine, and that she wouldn’t want cardiopulmonary resuscitation if her heart stopped. She also wouldn’t want to be fed through a tube if she was no longer able to eat. What was most important to her, though, was staying at home and avoiding a nursing home.

As a palliative care physician, I always urge my patients to complete advance directives. These are legal documents that tell doctors and family members what treatment they do and don’t want if they’re ever unable to make decisions for themselves. That’s important, because if I don’t know what my patients want, the default is to do everything to keep them alive, which typically results in unnecessary and costly treatment. Indeed, one of the most often-cited arguments for advance directives is the fact that 25 percent of Medicare spending is for people in the last year of life.

When my patient developed a cough and a fever, likely a result of pneumonia, she became too confused to make decisions for herself. Thanks to her advance directive, her family knew that she didn’t want aggressive treatment, and we knew that she wanted to stay home. So we arranged for short-term daily nursing visits and enough support so that, with additional help from her family, she was able to remain at home as she wanted.

I thought that she would get worse without aggressive treatment in the hospital, and that we would enroll her in hospice, so I was surprised when she began to improve. Soon she was able to make decisions for herself and even returned to the same level of independence that she’d had before she became sick. That’s when it became obvious to me that advance directives have their limits.

My patient lived, as many people with chronic, serious illnesses do, on a thin ledge of independence. The smallest nudge — a few missed medication doses, the loss of just a little support — left her entirely vulnerable. In my patient’s case, that nudge came two months later, when her neighbors ran into financial problems and their daughter, who had been doing the grocery shopping for my patient, had to take an after-school job. My patient valued her independence more than anything, so whenever her neighbors and her out-of-state family checked on her, or when we called her, she told us all that she was fine.

For three weeks, my patient subsisted on nothing but white rice, because that was all she had in the house. When her grand niece called us and asked us to check on her, we sent a social worker and a nurse to visit her. We found her housebound, surrounded by garbage, with no clean laundry and no toilet paper.

Despite our best efforts, we couldn’t do enough to keep her safe at home, so she went to live in a nursing home, where she spent the last two months of her life. An advance directive had helped her stay out of the hospital, as she had wanted. And perhaps it even made a bed available for someone who needed it more, as she’d hoped. But that piece of paper didn’t help her to live out her final months with the sort of comfort and dignity that she deserved.

When we talk about advance directives and reducing costly and unnecessary treatment at the end of life, we should also be talking about ways we can provide more support. We need to make sure that people like my patient have access to the kinds of care that can help them remain safely and comfortably at home.

Now when I help my patients complete an advance directive that defines the treatment they don’t want, we also discuss what support they’ll need in the future. I talk with my patients and their families about what’s going to be necessary to keep them safe and comfortable in their homes today, and next month and — if they’re lucky — for the next few years.

Those sorts of discussions are essential, but they’re not enough. We also need to revise the way we think about advance directives. Advance directives help reduce health care costs at the end of life by avoiding aggressive treatment, but that’s not the most compelling argument for them. It’s not enough to reduce what we spend on aggressive treatment at the end of life; we also need to spend those resources in better ways.

For someone around my patient’s age, the average cost of a hospitalization is about $13,000. So Medicare should have been willing to spend $13,000 to keep her safe and comfortable at home. That sum would have been more than enough to pay for a visiting nurse to continue to check on her after she recovered from pneumonia and a home health aide to help her with bathing and dressing. And it could have paid the girl next door to do her grocery shopping so a frail elderly woman didn’t need to subsist on white rice because it was the only food she had.

We should have been able to provide all of that help. My patient was adamant that she didn’t want to spend her last days of life in a hospital, taking up a bed that someone else could use. Let’s make sure that when people like her forgo costly treatment at the end of life, they get something in return.

Dr. David Casarett is a professor at the University of Pennsylvania Perelman School of Medicine and the author of “Stoned: A Doctor’s Case for Medical Marijuana.”

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A Mother’s Lesson: When Memory Fails, Delight in the Moment

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Credit Giselle Potter

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In 1988, the author’s mother wrote in The Times about her own mother’s dementia. <a href="http://timesmachine.nytimes.com/timesmachine/1988/01/31/399888.html?pageNumber=159">Read the full article in TimesMachine. </a>

In 1988, the author’s mother wrote in The Times about her own mother’s dementia. Read the full article in TimesMachine. Credit The New York Times

The first sign that the Alzheimer’s disease that ravaged my grandmother was back for her daughter was when Mom began having trouble saying “CNN.” She’d watched the cable news network for years with ferocious interest ever since returning from a life abroad in the Foreign Service to rural New Hampshire. There she nested in her mother’s house, saying she’d never move.

It was a distinctly peaceful life. I’d listen to her play the grand piano — the passion that had taken her to Juilliard decades earlier — and marvel at the lightness of her hands on the keys. On Sundays, she was the favorite lector at our church, reading the liturgy with an elegance instilled by her mother and grandmother, both trained elocutionists.

She also wrote and recorded essays on country living for NPR on subjects like “Mahler and Macaroni.” Words mattered a great deal to her. She mattered the world to me. I used to say I’d won the lottery when it came to mothers.

After Dad died, my mother continued to live alone in the big white house on the common. It was here in 1988 that she’d written a keenly observed Sunday commentary for this newspaper about her own mother’s battle with aging — and the dementia that “erased her life, line by line.”

She wanted me to promise that if her own light dimmed – or as she put it, “when I lose my mind too” – I wouldn’t upend my own life to care for her. But we never came up with a real plan.

About a year after CNN became “C…D…D…” and the home care team we’d improvised announced my mother’s decline was too much for them, my brothers and I barely convinced her to “visit” sunny California where my middle brother lived.

That visit became a new “post” in a fancy retirement community where, for $7,500 a month, she had her own studio and bathroom. She enjoyed music events and a stately dining room with a menu. There was even a church on the corner.

But like so many living with Alzheimer’s, Mom’s biorhythms were upside down. She’d often sleep during the day and be up all night doing what is known as “exit-seeking.”

Nights are the Achilles heel of most eldercare facilities staffed by the fewest caregivers — and the most inexperienced. Across the country, in many well-meaning Alzheimer’s units, memory care residents are treated with confinement.

So Mom “graduated” to the locked Memory Care unit for her “safety.” It broke my heart to watch her on tiptoes, peering through the locked door’s porthole across to the dining room she once enjoyed.

Alzheimer’s is not a mere matter of Swiss cheese memory and odd behaviors. It is a serious medical condition. It is terminal. It should be known for what it is: Brain Failure.

One morning, Mom emerged from her Memory Care room covered with bruises. The police came. The state came. There was even suggestion of a rape kit because my mother, clearly agitated, could say only, “the man, the man.”

We will never know what happened. But it stands to reason that if you lock up the most advanced Alzheimer’s residents with their attendant behavioral disorders, and apply nominal supervision, well, something is bound to happen. On the night in question, one newly hired caregiver attended 17 residents.

So we moved her again, this time to Seattle, close to my eldest brother and me, thereby violating the cardinal rule of Alzheimer’s care: thou shalt not move the patient. Change registers a full 10 on the Alzheimer’s Richter scale. The more Mom’s brain failed, the more I twirled to try to make things better.

Within a matter of weeks in the new place, she had fallen and broken her hip. Surgery followed, then three months in a rehab facility, and finally a move to a small adult family home with just six residents. She was exhausted and utterly disoriented. I was a wreck.

Still, I knew I was among the lucky ones. Despite the recent scan that showed her brain a mostly blank white slate, my mother somehow always managed to recognize me during our visits (although she’d begun calling me “Mom.”)

Where once I’d thought I’d lose my mind if she asked me the same question one more time, now I prayed to hear any full sentence just one more time. Ever the peripatetic family caregiver, I rarely stopped to inhabit my mother’s world: the one with no past, no future, just the present.

On our last Mother’s Day together, I took her to the big morning Mass at St. James Cathedral. As I attempted a Houdini maneuver getting her out of the car, up the curb and down the sidewalk to the church door, she somehow slithered from my grasp.

My mother sank to the ground in what seemed like slow motion. She never made a sound. She just lay there in the green grass in her rose-colored tweed suit, brilliant white hair glinting in the spring sun, blue eyes open wide, staring straight up into an unusually cloudless Seattle sky.

With church bells pealing through the cool morning air, my beautiful, brilliant mother stretched out her arms and made angels wings in the grass.

And all the doctors and all the medications and all the years of worry that couldn’t bring my mother back together again, also couldn’t defeat the magic of that moment.

I lay down next to her, threaded my fingers through hers, and for a brief wondrous moment, we held the present.

Mary Claude Foster is a journalist living in Seattle.

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Aging in Place

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Credit Paul Rogers

When I asked the other three members of my walking group, all of whom are in their mid to upper 70s, whether they had any concerns about future living arrangements, they each said they had none despite the fact that, like me, they live in multistory private homes without elevators and, in two cases, without bathrooms on every floor.

My Los Angeles son asked recently what I might do if I could no longer live in my house, and I flippantly replied, “I’m coming to live with you.” The advantages: I’d be surrounded by a loving and supportive family, and the warm weather is a benefit for someone like me who becomes increasingly intolerant of the cold with each passing year. The disadvantages: I’d lose a familiar community and a host of friends, and his house, unlike mine, is on a steep hill with no nearby stores; if I could no longer drive, I’d have to be chauffeured everywhere.

Probably my biggest deterrent would be relinquishing my independence and the incredible number of “treasures” I’ve amassed over the last half century. The junk would be easy, but parting with the works of art and mementos would be like cutting out my heart.

I suspect that most people are reluctant to think about changing where and how they live as long as they are managing well at the moment. Lisa Selin Davis reports in AARP magazine that “almost 90 percent of Americans 65 or older plan to stay in their homes as they age.” Yet for many, the design of their homes and communities does not suit older adults who lack the mobility, agility and swiftness of the young.

For those who wish to age in place, the authors of “70Candles: Women Thriving in Their 8th Decade,” Jane Giddan and Ellen Cole, list such often-needed home attributes as an absence of stairs, wide doorways to accommodate a walker or wheelchair, slip-resistant floors, lever-style door knobs, remotely controlled lighting, walk-in showers, railings, ramps and lifts. Add to these a 24-hour help system, mobile phone, surveillance cameras and GPS locaters that enable family members to monitor the well-being of their elders.

In many communities, volunteer organizations, like Good Neighbors of Park Slope in Brooklyn and Staying in Place in Woodstock, N.Y., help older residents remain in their homes and live easier and more fulfilling lives.

While many young adults chose to live and bring up children in the suburbs, a growing number of empty-nested retirees are now moving to city centers where they can access public transportation, shop on foot for food and household needs, and enjoy cultural offerings and friendly gatherings without depending unduly on others.

One reason my friends and I are unwilling to even consider leaving our Brooklyn community is our ability to walk to supermarkets, banks, food co-ops, hardware stores, worship and recreational facilities, and get virtually everywhere in the city with low-cost and usually highly efficient public transportation. No driving necessary.

We also wallow in the joys of near-daily walks in a big, beautiful urban park, remarking each time about some lovely vista — the moon, sunrise, visible planets, new plantings and resident wildlife.

Throughout the country, communities are being retrofitted to accommodate the tsunami of elders expected to live there as baby boomers age. Changes like altering traffic signals and street crossings to give pedestrians more time to cross enhance safety for people whose mobility is compromised. New York City, for example, has created Aging Improvement Districts, so far in East Harlem, the Upper West Side and Bedford-Stuyvesant, to help older people “live as independently and engaged in the city as possible,” Ms. Giddan and Ms. Cole wrote. In East Harlem, for example, merchants have made signs easier to read and provided folding chairs for seniors who wish to rest before and after shopping.

In Philadelphia, a nonprofit organization, Friends in the City, calls itself a “community without walls” designed to bring members closer to the city’s resources and to one another. It offers seniors a daily variety of programs to suit many cultural and recreational interests.

Also evolving is the concept of home sharing, in which several older people who did not necessarily know one another get together to buy a home in which to live and share responsibilities for shopping, cooking, cleaning and home repair. For example, in Oregon, Let’s Share Housing, and in Vermont, Home Share Now, have online services that connect people with similar needs, Ms. Giddan and Ms. Cole report. There’s also an online matching service — Roommates4Boomers.com — for women 50 and over looking for compatible living mates.

Of course, there are still many older adults, widows and widowers in particular, who for financial or personal reasons move in with a grown child’s family, sometimes in an attached apartment or separate floor. Host families may gain a built-in babysitter, and children can develop a more intimate relationship with grandma or grandpa.

For those with adequate finances, there is no shortage of for-profit retirement communities that help older people remain independent by providing supportive services and a host of amenities and activities. Some have extensive recreational and exercise facilities, as well as book and craft clubs, discussion groups and volunteer opportunities. Some take residents to theatrical productions and museums and on trips to nearby attractions.

I confess that retirement communities that house only older adults are not my style. I can’t imagine living in a place where I don’t see and interact with children on a daily basis. I find that nothing cheers me more than a smile or comment from a toddler. I guess I take after my father, who used to flirt with every child he noticed in a car near his. But I realize that, just as some people are averse to dogs, not everyone enjoys the companionship of a high-energy child.

For older people likely to require help with the activities of daily living, there are many assisted living facilities where residents can get more or less help, including aid with medications, feeding and ambulation, according to their changing needs.

And should I ever have to leave my home, Ms. Giddan and Ms. Cole point out that there is a new and growing cadre of professional organizers and moving managers to “help people sort through accumulated belongings, distribute and disperse what won’t be needed in the new setting, and assist with all stages of packing, moving and then unpacking, and staging the new home.”

This is the second of two columns about adjustments to aging. Read the first part: “Thriving at Age 70 and Beyond.”

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Seeing the Cycle of Life in My Baby Daughter’s Eyes

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Credit Giselle Potter

Like many new fathers, I spend as much of my free time as I can get away with gazing into my baby daughter’s eyes as she stutters and scans. I remember a day not long ago when I rocked my daughter, Eva, in my arms, and her eyes stopped and steadied as they looked back into mine. Her arms and legs ceased to rock and her entire body just relaxed. A chill went down my spine.

I felt that for the first time, she had really seen me. She was about 3 months old at the time. Within moments, though, her eyes left mine and started whirring around in their sockets again. While this was the first time I had shared such a moment of joy coupled with disappointment with her, I had experienced this many times with patients at the end of life.

Many have alluded to the symmetry of the beginning and the end of life. Most people, however, become parents long before they become caregivers. For me the order was reversed. For while I only recently became a father, medical training has made me much better acquainted with those at the opposite end of the spectrum.

The agony of death is more than just physical – it is an existential wound that gnaws away until there is slow, and frequently unwilling, acceptance of the inevitability of one’s mortality. I sometimes see a similar pain in my baby girl’s eyes as she makes another arduous journey – learning how to be alive. Frequently, as she cries when she is hungry, or cries when she is overfed, or cries as she tries to have a bowel movement, or just cries, it seems as if she is yearning to go back to the simple comforts of her mother’s womb.

Changes in the medical system have brought the medicalization of the shallow slopes of our bell-curve-shaped lives. At the start of the century, most lives started and ended at home. However, while hospitals started to become the place where we took both our first breaths and our last in the 20th century, in recent years people have become eager to reverse both trends. Nutrition, too, has shifted from being completely natural, to being almost exclusively artificial formula for children and tube feeding and intravenous nutrition for the terminally ill, followed now by a realization that natural routes are best for both groups. What hasn’t changed, and what binds the pediatric and the geriatric, is the obsession with their bowel movements.

As medical science has progressed, while we have extended life, we have transformed death from a singular event, into dying, an entire phase of our lives that can last from days to years. This is mirrored by an extension of childhood as well, with children being more dependent for a longer period of time than ever before in human history. Parenting therefore has become more demanding – and more expensive.

Caregiving for those at the end of life, as those who live it will attest, is equally arduous yet is barely recognized at a similar scale. In some ways, caregiving is similar to parenting – women do most of the heavy lifting. In fact, two-thirds of all caregivers are female. Yet, caregiving for the dying is different from parenting because it does not yet have a formally recognized role within the care of the patient. While there is no chance Eva would ever see her pediatrician without her parents, elderly patients, some with levels of dependency equal to that of a 3-month-old, present to the hospital or clinic all by themselves, all the time. Furthermore, while there is much debate about paying workers through maternity or paternity leave, a similar discussion does not exist around whether leave granted to those caring for parents or loved ones at the end of life, particularly those getting home hospice services, should be paid.

Part of the problem is also how differently we view infancy and old age. A daily struggle my wife and I face is how to hold back from oversharing pictures and videos of Eva on social media. We document her life meticulously, afraid of letting any single gesture slip away. Yet, not only do we siphon off old people to live outside of our immediate circles, but images of what the end looks like are scant, uncelebrated and frequently morbid. There is a significant disparity of empathy toward children versus the elderly. Children’s shortcomings turn into viral YouTube videos, while those of the elderly are often derided and ridiculed by the very people charged with taking care of them.

In a more longitudinal sense, we care for our young the same way people have for thousands of years yet how we die has changed significantly over just the past few years and continues to be in flux. Advanced technology means that many people require much more assistance at home than before. Furthermore, while our lifespan has been extended dramatically, the years we spend with disability have also increased. Therefore, while we have had eons to define our roles as parents, the modern caregiver remains undefined and unrecognized, and thus, unsupported. Investing in children makes intuitive sense, but a similar case has not been built for taking care of the elderly.

As with raising a baby, the answer might come from the heart. What is really needed is for us to love the old as we do the new and celebrate the end as we do the beginning.

Haider Javed Warraich, M.D., a fellow in cardiology at Duke University Medical Center, is the author of the book “Modern Death – How Medicine Changed the End of Life,” coming in February 2017.

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Thriving at Age 70 and Beyond

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Credit Paul Rogers

A recently published book, “70Candles! Women Thriving in Their 8th Decade,” inspired me to take a closer look at how I’m doing as I approach 75 and how I might make the most of the years to come. It would be a good idea for women in my age cohort to do likewise. With a quarter of American women age 65 expected to celebrate their 100th birthday, there could be quite a few years to think about.

It’s not the first time I’ve considered the implications of longevity. When one of my grandsons at age 8 asked, “Grandma, will you still be alive when I get married?” I replied, “I certainly hope so. I want to dance at your wedding.” But I followed up with a suggestion that he marry young!

Still, his innocent query reminded me to continue to pursue a healthy lifestyle of wholesome food, daily exercise and supportive social connections. While there are no guarantees, like many other women now in their 70s, I’ve already outlived both my parents, my mother having died at 49 and my father at 71.

If I have one fear as the years climb, it’s that I won’t be able to fit in all I want to see and do before my time is up, so I always plan activities while I can still do them.

I book cycling and hiking trips to parts of the world I want to visit and schedule visits to distant friends and family to be sure I make them happen. In a most pragmatic moment, I crocheted a gender-neutral blanket for my first great-grandchild, but attached a loving note in case I’m no longer around to give it in person.

Of course, advancing age has taken — and will continue to take — its incremental toll. I often wake up wobbly, my back hates rainy days, and I no longer walk, cycle or swim as fast as I used to. I wear sensible shoes and hold the handrail going up and down stairs.

I know too that, in contrast to the Energizer Bunny life I once led, I now have to husband my resources more carefully. While I’m happy to prepare a dish or two for someone else’s gathering, my energy for and interest in hosting dinner parties have greatly diminished. And though I love to go to the theater, concerts, movies and parties, I also relish spending quiet nights at home with my Havanese, Max, for company.

Jane Giddan and Ellen Cole, the authors of “70Candles!,” do not tout their work as definitive research. Rather, their effort involved scores of posts to an online blog, and eight gatherings in different cities with groups of women in or near their 70s, where participants were encouraged to share their stories and generate research questions that could be explored scientifically in more detail. Such studies are important: As baby boomers age, women in their 70s, already a large group, will represent an increasing proportion of the population, and how to best foster their well-being will be a growing challenge.

What are the most important issues facing these women as they age, and how might society help ease their way into the future? Leading topics the women chose to explore included work and retirement, ageism, coping with functional changes, caretaking, living arrangements, social connections, grandparenting and adjusting to loss and death.

As members of the first generation in which huge numbers of women had careers that defined who they were, deciding when to bow out can be a challenge. Some have no choice, others never want to, and still others like me continue to work part-time. However, sooner or later, most will need to find rewarding activities to fill their now-free time.

The authors reported that “the women seemed to fear retirement before the deed was done, and then to relish their newfound opportunities afterward.” Several warned against rushing into too many volunteer activities, suggesting instead that retirees take time to explore what might be most meaningful and interesting, from taking art classes or music lessons to mentoring students, becoming a docent or starting a new career.

As one woman said, “There are many places where you are needed and can make a difference.” Another said, “It’s more like putting new tires on a car… re-tiring!”

Still, many lamented society’s focus on youthfulness and its failure to value the wisdom and knowledge of elders like themselves. Ageism abounds, they agreed. As one woman wrote, “At my institution, there’s an unstated policy that anyone over 55 won’t get a job. We’re thought to be out of touch with the younger population and assumed to be lacking in the necessary technical skills.” A practicing attorney admitted, “People might not listen to me if they knew I was 71, so I keep it to myself.”

Adjusting to physical changes that accompany advancing years is often tough. Grandchildren, though a great joy to many, can be exhausting, necessitating a restorative nap. Adjustments are needed to reduce the risk of falls and fractures. Better lighting, hearing assists, a reliance on Post-it notes and lists as well as canes and walkers can become essential for safe and effective functioning.

As Ms. Giddan and Ms. Cole wrote, “Our bodies change as we age, even when we eat healthfully, exercise and try to take good care of ourselves. Sight, hearing, bones, joints, balance, mobility, memory, continence, strength and stamina — they will never be what they once were.”

There is also the matter of attending to or accommodating various aches and pains. As one physician reassured a woman of 70, “All my patients your age who are free of pains are dead.” I’m not one to run to the doctor the moment something hurts. Rather, I give it a few weeks — maybe a month — to see if it will go away on its own. Even if fully covered by Medicare, doctor visits cost time and effort, and tests that ensue may have side effects.

Also important as women age are social connections, especially with other women. Whether married, single, widowed or divorced, participants reported that women friends were their greatest source of support and comfort.

Perhaps most important, for men as well as women, is to think positively about aging. A 2002 study by epidemiologists at Yale found that “individuals with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive perceptions.”

This is the first of two columns on adjustments to aging.

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Millions With Leg Pain Have Peripheral Artery Disease

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Credit Paul Rogers

More than eight million older Americans have a condition that can cause leg pain when they walk even short distances. Yet half of those who have the condition don’t know it and consequently don’t get treated for it, putting themselves at risk for a heart attack, stroke or worse.

The condition, called peripheral artery disease, or P.A.D., is marked by diseased or blocked arteries in the legs. More than half of those with such circulatory problems in the extremities also have coronary or cerebral artery disease, noted Dr. Iftikhar J. Kullo, a cardiovascular specialist at the Mayo Clinic, in The New England Journal of Medicine in March. Failure to diagnose and treat blocked arteries elsewhere in the body can result in more serious, or even fatal, problems if they affect the heart or brain.

It may seem odd that people who have serious difficulty walking normal distances would not know something is wrong and get checked out. Yet, as Dr. Kullo noted, P.A.D. is both underdiagnosed and undertreated. And the number of cases of P.A.D. is only likely to rise as the population ages, he said.

“A lot of people limit their activity for other reasons, like a hip problem, back pain or breathing difficulty, and may not push themselves hard enough to provoke symptoms of P.A.D.,” said Dr. Paul W. Wennberg, a cardiologist and specialist in vascular disease at the Mayo Clinic. Or they may think their limited ability to exercise is to be expected, given their advancing years. Still others, Dr. Wennberg said, “may have only minimal disease in their legs, or they adapt their lifestyle to where they don’t notice symptoms anymore.”

In other words, since walking brings on pain, people typically find myriad ways to avoid doing it.

But this very response — remaining sedentary — is counterproductive, Dr. Wennberg said, because the best treatment for P.A.D. is exercise: Walking up to the point of pain, then resting until the pain subsides, then walking again, repeating the sequence until you’ve walked for 20 to 30 minutes (not counting rests) every day.

With this approach, Dr. Wennberg explained, exercise tolerance gradually increases as collateral blood vessels form in the legs that can compensate for blockages in the main arteries.

Just as teachers often have star pupils, Dr. Wennberg talks fondly of a man who was his star patient. When first seen, the patient, a 76-year-old Minnesotan, was afflicted with such severe peripheral artery disease that he couldn’t walk much beyond his backyard. Although a nonsmoker, the man had chronic obstructive pulmonary disease, which also limited how far he could walk. Yet he desperately wanted to be able to hike the nature trail behind his house, which motivated him to follow the doctor’s prescription religiously: Walk until it hurts, rest, then walk some more. Repeat several times a day.

“He got a treadmill to use in his house, and he walked outside whenever he could,” Dr. Wennberg recalled. “In just three months, he had doubled his walking distance as measured on a treadmill in the lab, and before long he was able to walk the mile-long nature trail.” Not only did the exercise prescription reduce his leg pain, it also improved his breathing. Together, these benefits enabled him to walk the desired distance without pain or fatigue.

Another of Dr. Wennberg’s patients, Donovan Merseth, 76, of Zumbrota, Minn., said he walks his two dogs four or five times a day, accumulating daily walks of three to four miles. “The more active I am, the better I feel,” Mr. Merseth said in an interview. “I walk at a moderate pace,” he said, calling his exercise “a senior power walk.”

Variable symptoms present another stumbling block to getting a correct diagnosis of P.A.D. The discomfort P.A.D. causes “is more often atypical than typical,” Dr. Wennberg wrote in the journal Circulation. “Descriptions such as ‘tired,’ ‘giving way,’ ‘sore,’ and ‘hurts’ are offered more often than ‘cramp’,” which can challenge an examining physician’s ability to suspect P.A.D. as the cause of a patient’s discomfort.

He suggested that doctors ask, “What’s the most strenuous thing you do in a typical week? Do you do any routine exercise, like walking? Do you get pain when you walk?”

A simple noninvasive test that can be done in any doctor’s office, called the ankle-brachial index, or ABI, test, can reveal the likelihood of P.A.D. The test, which takes only a few minutes, compares blood pressure measured at the ankle with blood pressure measured in the arm. Lower pressure in the leg is an indication of P.A.D.

The index is calculated by dividing the systolic (top number) blood pressure in the arteries near the ankles by the systolic blood pressure in the arms. A low number strongly suggests a narrowing or blockage in the arteries that supply blood to the legs.

Follow-up tests, like an ultrasound exam of the arteries to the brain, may be done as well. “If there’s blockage in one area of the body, it’s likely also to be in another,” Dr. Wennberg noted.

Not surprisingly, the risk factors for P.A.D. closely match those for coronary heart disease: smoking (currently or formerly), diabetes, high blood pressure and high cholesterol. Consider asking your doctor to do the ABI test if you are 50 or older and have any of the above risk factors, even if you haven’t yet noticed a problem with walking (though insurance may not cover the cost if you lack symptoms).

However, Dr. Wennberg wrote, the ABI test done during rest may miss peripheral artery disease in nearly one-third of patients; they may require an ABI test following exercise on a treadmill to reveal the problem. The blood pressure measurements must be taken within a minute of stopping the exercise.

Given the same risk factors, African-Americans are more likely than Caucasians to develop P.A.D.

The average age at which people develop P.A.D. is 70, Dr. Wennberg said, adding that it occurs a decade earlier in people with diabetes and even earlier in people who both smoke and have diabetes.

Smoking increases the risk of developing P.A.D. fourfold, and more than 80 percent of people with the condition are current or former smokers.

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On Widower Watch

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Credit Stuart Bradford

He crossed the marbled lobby of his building, headed for the front door, leaning into his blue walker as if he were facing a gale-force wind. A golden starburst of drying urine ringed the front of his khaki pants. I thought we were meeting in his apartment, but one of us had the time wrong.

As a hospice volunteer for his late wife, I had traveled from my home in Brooklyn to the Upper West Side every Sunday for the last four years to spend time with them, adding more visits when they needed help with household tasks. When she died, I could hardly abandon him. We had, over the course of all our time together, become a kind of family.

Widowers are endangered beings, challenged by grief and its grim companions: loneliness, disorientation and a statistically high mortality rate. A 2012 study by a team at Rochester Institute of Technology showed that widowers are 30 percent more likely to die after the recent death of a spouse, compared to normal risks of mortality. The first six months after widowhood are the most challenging, but the effects of grief can last up to a decade.

At 90, the man I come to visit every week has a host of complicating ailments: He lives with a colostomy bag; his feet are permanently swollen and flaky with gout; he was given a diagnosis of prostate cancer more than a decade ago. It’s a slow growing cancer, and while he had treatment for it, he suspects that some of his current urination problems are a result. These health factors would be challenging enough on their own, but now they are compounded by profound grief.

It had been only eight weeks since he and I had watched his wife take her last breath on the sofa in their apartment upstairs. Her companionship — they had been married for 53 years — had long dictated his daily schedule; for years her illness required him to carry on with the duties of the household. With his wife gone, his routine gave way to a morass of unaccountability and unwelcome quiet.

It would be easy to be rebuffed by his stoical insistence that he’s fine, but his family and I have begun to track his emotional and physical wellness in a number of ways in the hope that we can forestall the typical effects of new widowhood. Which is why, as he and I stood in the lobby, I anxiously checked the time on my watch, vigilant for any indication that he was encountering psychological or physical difficulties.

He seemed a little confused about what day it was. Yet his thin white hair was neat; his sneakered steps deliberate and sure. His eyesight has been quickly fading over the past few years, but he continues to watch TV, and he is in charge of his hygiene and his schedule for all but four hours a day when his aide comes to cook his evening meal. Despite his soiled clothes, he seemed to be managing his activities of daily living (what gerontologists call A.D.L.s) successfully.

Social isolation is a risk many widowers face, compounded by solitary living. A Pew Research study reported in February showed that an increased number of men live alone: 18 percent, up from 15 percent in 1990. According to AARP, 90 percent of those over 65 wish to stay at home as long as possible.

Although his daughters call and visit frequently, they both live far away. Most of his friends are long dead and he is not a member of a synagogue or senior center, organizations that can often provide continuity and support to elder widowers. My weekly visits, and those of his niece and others, are important to ensure that he socializes.

Mobility can also be an inhibiting factor to maintaining social ties and physical health. Although he is still able to take the bus to doctors’ appointments across town, he tires easily. Some taxis can’t accommodate his walker, and his swollen feet and fading eyesight put him at risk for falling. The National Council on Aging notes that falls are the leading cause of fatal and nonfatal hospital admissions among the elderly. A misplaced step could lead to depression, feelings of helplessness and increased isolation during recovery. Still, it’s important to him that he remain independent as long as possible, which means he’s learning to balance mobility with safety.

Unlike many of his peers, my friend owns his home and has adequate finances to last until the end of his life, even if he increases the visiting hours of his home health aide. But in New York City alone, 20 percent of those over 65 live below the poverty line. Because the federal poverty rate is so low — $11,770 a year for a single person — many elderly people don’t qualify for the benefits they need, particularly in urban areas where housing and insurance rates can be higher.

According to a recent study by the University of California, Los Angeles’s Center for Health Policy Research, an increased number of senior citizens in California are experiencing “worse health, more depression and less access to care.” Because widowhood can decrease household income and other resources, those who have recently lost a spouse are particularly susceptible to this trend.

He will turn 91 this month. His older daughter is coming up from Virginia to host a party in his honor. I’ll pick up a cake, ordered by his younger daughter in Colorado, from his favorite bakery on the Upper East Side. We’ll drink champagne to toast his health, and we’ll miss his wife on this first birthday without her.

Marking family and personal occasions in this way has become increasingly important to all of us; these events intersect long, quiet weeks with laughter and company. And here’s the often unacknowledged benefit to keeping watch on a widower: With my grandparents dead and my friends all around my age, he diversifies my social life as much as I do his. He gives me a perspective on the city we live in that my peers simply don’t have. We spend our time together talking about our dissimilar lives and the things that matter to us, reminiscing about his many rich years, and looking up old poems in the vast library that lines the walls of his house. He is my friend and I miss him when I am away. As it turns out, nonagenarians are good company.

Ann Neumann is a visiting scholar at the Center for Religion and Media at New York University and the author of “The Good Death: An Exploration of Dying in America.”

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Walk, Jog or Dance: It’s All Good for the Aging Brain

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Credit Illustration by Sam Island

More people are living longer these days, but the good news comes shadowed by the possible increase in cases of age-related mental decline. By some estimates, the global incidence of dementia will more than triple in the next 35 years. That grim prospect is what makes a study published in March in The Journal of Alzheimer’s Disease so encouraging: It turns out that regular walking, cycling, swimming, dancing and even gardening may substantially reduce the risk of Alzheimer’s.

Exercise has long been linked to better mental capacity in older people. Little research, however, has tracked individuals over years, while also including actual brain scans. So for the new study, researchers at the University of California, Los Angeles, and other institutions analyzed data produced by the Cardiovascular Health Study, begun in 1989, which has evaluated almost 6,000 older men and women. The subjects complete medical and cognitive tests, fill out questionnaires about their lives and physical activities and receive M.R.I. scans of their brains. Looking at 10 years of data from nearly 900 participants who were at least 65 upon entering the study, the researchers first determined who was cognitively impaired, based on their cognitive assessments. Next they estimated the number of calories burned through weekly exercise, based on the participants’ questionnaires.

The scans showed that the top quartile of active individuals proved to have substantially more gray matter, compared with their peers, in those parts of the brain related to memory and higher-­level thinking. More gray matter, which consists mostly of neurons, is generally equated with greater brain health. At the same time, those whose physical activity increased over a five-year period — though these cases were few — showed notable increases in gray-matter volume in those same parts of their brains. And, perhaps most meaningful, people who had more gray matter correlated with physical activity also had 50 percent less risk five years laterof having experienced memory decline or of having developed Alzheimer’s.

“For the purposes of brain health, it looks like it’s a very good idea to stay as physically active as possible,” says Cyrus Raji, a senior radiology resident at U.C.L.A., who led the study. He points out that “physical activity” is an elastic term in this study: It includes walking, jogging and moderate cycling as well as gardening, ballroom dancing and other calorie-burning recreational pursuits. Dr. Raji said he hopes that further research might show whether this caloric expenditure is remodeling the brain, perhaps by reducing inflammation or vascular diseases.

The ideal amount and type of activity for staving off memory loss is unknown, he says, although even the most avid exercisers in this group were generally cycling or dancing only a few times a week. Still, the takeaway is that physical activity might change aging’s arc. “If we want to live a long time but also keep our memories, our basic selves, intact, keep moving,” Dr. Raji says.

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Reinventing Yourself: Stories From Our Readers

In a recent column, Jane E. Brody wrote about several people who had reinvented themselves. Some had changed their lives because they were no longer happy in their chosen careers, while others simply needed a change or were driven by a new-found passion.

We asked our readers to tell us how they had reinvented themselves. As usual their stories did not disappoint. Here are a few of our favorites, from a woman traveling the country as a volunteer to the late-in-life rabbi to the 70-year-old yoga instructor.

From Mailman to Teacher

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Frank spends some time with one of his students.

Frank spends some time with one of his students.Credit

“Upon retiring from a 30-year career as a humble mailman, I began volunteering in my granddaughters’ school. I quickly found that I really, really liked working with kids, and I spent a year training with Americorps as a reading tutor for struggling students. This training has given me an encore career as a substitute special-education assistant in the public schools. It’s joyful, very challenging and immensely satisfying, maybe even rejuvenating. Compared with my old days, as Bob Dylan says, ‘I was so much older then, I’m younger than that now.’”

Frank Robertson, Seattle

The Professional Volunteer

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Ms. Traynor rides a water buffalo while volunteering at Heifer Ranch in Arkansas.

Ms. Traynor rides a water buffalo while volunteering at Heifer Ranch in Arkansas.Credit

“After a 45-year career as an administrative assistant, most of that time as a single parent, I would have loved to retire, but without adequate financial resources, what could I do? It it was time to be creative.

I received a call from friends saying they had found a a small college in Sitka, Alaska, where the administration welcomed volunteers, offering free room and board. I began to rethink retirement. After all, all I needed do was get there!

It was a full calendar year before I was ready. In July, 2005, I retired. Feeling like Joan of Arc, I drove out of my driveway on my way to Alaska and never looked back.

I found that I was welcomed by any organization I approached to help, that college in Alaska, Heifer Ranch in Arkansas, Menaul School in New Mexico, a wildlife refuge in Florida, plus many others. I have traveled the entire country on a fixed income, getting out and giving back, always receiving more than I contribute, making many new friends in the process.”

Barbara M. Traynor
Slingerlands, N.Y.

The Later-In-Life Rabbi

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“After having a successful career as a screenwriter for 25 years, I decided to become a rabbi. I entered rabbinical school at age 54 and it took nine years for me to graduate. Today, at age 66 I am one of eight rabbis at Wilshire Boulevard Temple, the biggest and oldest synagogue in Los Angeles.”

Susan Nanus
Los Angeles

The Lawyer Who Became a Chaplain

“After 40 years working as an attorney, I retired from the law in 2014 to enter a six-month chaplaincy internship program at Brigham and Women’s Hospital. This led to volunteering as a chaplain at Boston Medical Center for six months and then a six-month chaplaincy internship at Boston Medical Center. I was later hired by Boston Medical Center as a per diem chaplain to help out on the weekends and one day a week.

The chaplaincy work is intense, typically comforting patients and families whose lives have changed dramatically and precipitously. As a 70-year-old, I feel incredibly fortunate to be able to engage the world in this way.”

Bill Crane
Boston

The Financially Savvy Actress

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“In 2008, I graduated college with a degree in drama and boarded a plane to the Philippines as a cast member on the international tour of ‘Cinderella,’ the musical. While performing in Asia, however, the American economy was in the midst of a meltdown. So, by the start of 2009, I was back in New York City, a young, recently unemployed actress at the height of the financial crisis.

I dove deep into personal finance, learning as much as I could. I sat at the back of the show’s tour bus every evening, plugging my daily expenses into spreadsheets. I studied investment principles while taking the subway home after late-night restaurant shifts.
As I began to share the tips and tricks I had uncovered with peers, I stumbled upon an eager audience: Regular people were struggling to get a grasp on their money, lost in the jargon and obscurity of traditional financial institutions and media.

I now use my love of theater and storytelling to teach young audiences how to leverage the powerful tools of personal finance and entrepreneurship to build a life on their own terms. The messages of change, progress and gratitude I receive in reply are more gratifying than any curtain call or on-stage bow I’ve ever taken.”

Stefanie O’Connell
New York

Back to School at 53

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“After 14 years doing a combination of engineering, teaching English in China and social justice work, I decided to take stock of my life. I’m now 53 years old and in my second year of graduate school studying for a master’s degree in clinical mental health counseling.

Reading articles, writing papers and engaging with my much-younger peers has invigorated my mind and energized my desire for my soon-to-be new vocation. While many of my peers are trekking to work, I’m in my jeans and sneakers making my way to classes with plenty of caffeine and snacks as I plow through my coursework. Frankly, it’s hardly work to me. Rather, it’s just part of a journey of not only reinvention but rediscovery of who I am and what I care about. It’s taken me nearly 30 years but I’m getting there!”

Elena Yee
Providence, R.I.

The 70-Year-Old Yoga Instructor

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I” retired from a job with the state of N.Y. about 15 years ago. At the time, I had been practicing yoga for about 20 years. I was offered an opportunity to teach at a senior center in the area and agreed to do it. I based my classes on what my teachers had been teaching me over the years. About seven years ago, I began training to be a yoga teacher at the age of 70. That was very challenging for someone who had taken her last college course many years earlier. I was the oldest person in my class to complete the training.

Today, I teach about five classes a week, some at my home where I have transformed my former dining room into a small studio. Most of my students are older and have some limitations physically and I try to accommodate my students’ needs. This ‘new’ career brings me great joy and satisfaction. I consider myself to be a very lucky woman!”

Claire Malone
Delmar, N.Y.

A New Career Working With Seniors

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“After 25 years of working in financial services, I am now the executive director of an assisted living community. When the job market for financial executives became more challenging during the recession, I looked around for a back-up plan.

I found assisted living after helping a friend’s mother who was sick. After helping her, I volunteered at a local assisted living. I loved working with seniors! I got my master’s degree in gerontology and started a position as business director of an assisted living community within a few months of each other. In 2013, I was promoted to executive director of our assisted living community. Every day is a good day. I love what I do and I think it shows.”

Betsy Connolly
Wayland, Mass.

Using the Arts to Promote Healthy Aging

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Credit Paul Rogers

Throughout the country, the arts are pumping new life into the bodies and minds of the elderly.

Two summers ago, a remarkable documentary called “Alive Inside” showed how much music can do for the most vulnerable older Americans, especially those whose memories and personalities are dimmed by dementia.

The film opens with a 90-year-old African-American woman living in a nursing home being asked about her life growing up in the South. All she could say in response to specific questions was, “I’m sorry, I don’t remember.”

But once she was fitted with an iPod that played the music she had enjoyed in her youth, her smile grew wide and her eyes sparkled as vivid memories flooded her consciousness. She was now able to describe in detail the music and dances she had relished with her young friends.

At another nursing home, a man named George with advanced dementia refused to speak or even raise his head when asked his name. He too was outfitted with an iPod, and suddenly George came back to life, talking freely, wiggling to the music in his wheelchair and singing along with the songs he once loved.

The Music and Memory project that provided the iPods was the inspiration of a volunteer music lover named Dan Cohen, and has since spread to many nursing homes and facilities for the aged around the country. Alas, not nearly enough of them. Medicaid, which fully covers the cost of potent drugs that can turn old people into virtual zombies, has no policy that would pay for far less expensive music players. So the vast majority of nursing home residents who might benefit are deprived of this joyous experience.

Nonetheless, across the country, the arts in their myriad forms are enhancing the lives and health of older people — and not just those with dementia— helping to keep many men and women out of nursing homes and living independently. With grants from organizations like the National Endowment for the Arts and the National Institute on Aging, incredibly dedicated individuals with backgrounds in the arts have established programs that utilize activities as diverse as music, dance, painting, quilting, singing, poetry writing and storytelling to add meaning, joy and a vibrant sense of well-being to the lives of older people.

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Walter Hurlburt, 90, decorates rooms at the Burbank Senior Artists Colony, a retirement facility where he lives.

Walter Hurlburt, 90, decorates rooms at the Burbank Senior Artists Colony, a retirement facility where he lives.Credit

Through a program called EngAGE in Southern California, 90-year-old Walter Hurlburt, who once made a living as a sign painter, now decorates rooms at the Burbank Senior Artists Colony, a retirement facility where he lives, with lovely oil paintings he creates from pictures he finds in magazines and books. Mr. Hurlburt regularly attends classes on various art forms at the residence where, he told me, “I’m always learning something new.”

His buddy at the residence, Sally Connors, an 82-year-old former schoolteacher, surprised herself by writing and directing a screenplay that was performed by fellow residents. Then, with Dolly Brittan, 79, a former early childhood educator, they both surprised themselves by writing their life stories in rap and performing their rap memoirs on a stage for at-risk teenagers they were mentoring.

Both she and Ms. Connors said their newfound involvement with the arts has made them feel decades younger.

Tim Carpenter, the executive director of EngAGE, is now working to expand this approach to senior living in other cities, including Minneapolis, Portland, Ore., and Raleigh, N.C. His goal is to create a nationwide network of programs for seniors that keep them healthy, happy and active through lifelong learning in every conceivable art form, enabling them to live independently as long as possible.

As in Burbank, Mr. Carpenter is promoting the development of arts colonies in senior residences where residents can study and create art in all its forms and where they can see their artistic creations come to life on a stage.

Dr. Gene D. Cohen, a gerontologist at George Washington University who died in 2009, was a staunch advocate for the mental and physical benefits of creativity for the elderly. He directed the Creativity and Aging Study, a controlled study sponsored by the National Endowment for the Arts at three sites, including Elders Share the Arts in Brooklyn, N.Y., that showed after only a year that the health of elders in the cultural groups stabilized or improved in contrast to a decline among those in the control groups.

In a film called “Do Not Go Gently,” Dr. Cohen, who founded the Creativity Discovery Corps, featured an architect who, at age 96, submitted a plan for redeveloping the World Trade Center site. Dr. Cohen pointed out that creativity challenges the mind and results in the formation of new dendrites, the brain’s communication channels.

At 26 different facilities in the Washington, D.C., area, 15 teaching artists work with seniors in centers where they live or visit regularly. Janine Tursini, director of Arts for the Aging in Rockville, Md., seeks to “get at what best jazzes up older adults.” Groups of about 20 older adults get involved in what she calls “art making” — music, dance, painting or storytelling.

Ms. Tursini said the N.E.A.-sponsored study showed that when older people become involved in culturally enriching programs, they experience a decline in depression, are less likely to fall and pay fewer visits to the doctor. In another study among people with Alzheimer’s disease, a sculpting program improved the participants’ mood and decreased their agitation even after the program ended.

“The arts open people up, giving them new vehicles for self-expression, a chance to tell their stories,” Ms. Tursini said. “The programs capitalize on assets that remain, not on what’s been lost.”

Naomi Goldberg Haas created the Dances for a Variable Population program to get older adults dancing. People who haven’t moved in years, even those who can no longer stand, can participate. Young professionals and older dancers go to various sites — libraries, churches, senior centers — where elders gather and encourage them to “move more.”

“Movement enriches the quality of their lives,” Ms. Haas said. “It’s absolutely healing. Balance, mobility, strength — everything improves.”

Social engagement, which nearly all these programs provide, has been repeatedly found in major population studies to prolong life and enhance healthy aging. Clinically, the programs have been linked to lowered blood pressure, reduced levels of stress hormones, and increased levels of the “happiness hormones” that are responsible for a runner’s high.

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Pursuing the Dream of Healthy Aging

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Credit Paul Rogers

Given their druthers, most people would opt for a long and healthy life. Few relish the idea of spending years, even decades, incapacitated by illness, dependent on caregivers and unable to enjoy the people, places and activities that make life worth living.

In 1980, Dr. James F. Fries, a Stanford University physician who studied chronic disease and aging, proposed that a “compression of morbidity” would enable most people to remain healthy until a certain age, perhaps 85, then die naturally or after only a brief illness.

Now, a prescient group of experts on aging envisions a route to realizing Dr. Fries’s proposal: one or more drugs that can slow the rate of aging and the development of the costly, debilitating chronic ailments that typically accompany it. If successful, not only would their approach make healthy longevity a reality for many more people, but it could also save money. They say that even a 20 percent cut in how fast people age could save more than $7 trillion over the next half-century in the United States alone.

“Aging is by far the best predictor of whether people will develop a chronic disease like atherosclerotic heart disease, stroke, cancer, dementia or osteoarthritis,” Dr. James L. Kirkland, director of the Kogod Center on Aging at the Mayo Clinic, said in an interview. “Aging way outstrips all other risk factors.”

He and fellow researchers, who call themselves “geroscientists,” are hardly hucksters hawking magic elixirs to extend life. Rather, they are university scientists joined together by the American Federation for Aging Research to promote a new approach to healthier aging, which may — or may not — be accompanied by a longer life. They plan to test one or more substances that have already been studied in animals, and which show initial promise in people, in hopes of finding one that will keep more of us healthier longer.

As Dr. Kirkland wrote in a new book, “Aging: The Longevity Dividend”: “By targeting fundamental aging processes, it may be possible to delay, prevent, alleviate or treat the major age-related chronic disorders as a group instead of one at a time.”

His colleague S. Jay Olshansky, a gerontology specialist in the School of Public Health at the University of Illinois in Chicago, said it is often counterproductive to treat one disease at a time. Preventing cardiac death, for example, can leave a person vulnerable to cancer or dementia, he explained.

A better approach, Dr. Kirkland said, would be to target the processes fundamental to aging that underlie all age-related chronic diseases: chronic low-grade inflammation unrelated to infection; cellular degradation; damage to major molecules like DNA, proteins and sugars; and failure of stem cells and other progenitor cells to function properly.

The team, which includes Dr. Nir Barzilai, director of the Institute for Aging Research at Albert Einstein College of Medicine in The Bronx, and Steven N. Austad, who heads the biology department at the University of Alabama at Birmingham, plans to study one promising compound, a generic drug called metformin already widely used in people with Type 2 diabetes. They will test the drug in a placebo-controlled trial involving 3,000 elderly people to see if it will delay the development or progression of a variety of age-related ailments, including heart disease, cancer and dementia. Their job now is to raise the $50 million or so needed to conduct the study for the five years they expect it will take to determine whether the concept has merit.

The project represents a radical departure from ordinary drug studies that test treatments for single diseases. However, the group, spearheaded by Dr. Barzilai, said the Food and Drug Administration has endorsed their idea to test a single substance for effectiveness against a range of ailments.

“If metformin turns out not to work, there are several other substances in the pipeline that could be tried,” Dr. Barzilai said. “Under the auspices of the National Institute on Aging, three research centers have tested 16 substances in different animal models and got incredible results with four of them.”

Green tea, one of those tested, bestowed no health or life span benefits, despite its popularity. But the drug rapamycin, an immune modulator used following organ transplants, was most effective among those tested, Dr. Barzilai said.

The team is starting with metformin because it is a cheap oral drug — costing about two cents a pill — with six decades of safe use in people throughout the world. Among those with Type 2 diabetes who have taken it for years, there is evidence suggesting that, in addition to diabetes, it protects against cardiovascular disease, cancer and possibly cognitive impairment, Dr. Kirkland said, adding that “it targets the fundamental processes of aging, which tend to be linked.”

Dr. Barzilai said, “Our goal is to establish the principle of using a drug, or two in combination, to extend health span. The best we can expect from metformin is two or three additional years of healthy aging. But the next generation of drugs will be much more potent.”

Dr. Barzilai is already conducting a complementary study of centenarians, the results of which could identify more drugs to delay age-related diseases. He and colleagues are isolating genes that appear to keep these long-lived men and women healthy for 20 to 30 years longer than other people and shorten the length of illness at life’s end. Several studies have already found that individuals with exceptional longevity experience a compression of morbidity and spend a smaller percentage of their life being ill, Dr. Barzilai and his colleague Dr. Sofiya Milman wrote in the “Aging” book.

By analyzing the action of genes that extend health span, “it should be possible to devise drugs that mimic the genes’ effects,” he said. Two such gene-based drugs that show early promise against age-related diseases are already being tested.

But until definitive studies are completed and substances are shown to be safe as well as effective in prolonging health, Dr. Olshansky cautioned against dosing oneself prematurely with widely touted substances like resveratrol, the antioxidant found in red grapes and wine, or growth hormone.

Consumers must exercise caution, he warned, because “there’s an entire industry out there trying to market the products we’re testing before they are adequately evaluated.”

He also emphasized that taking a drug found to ward off age-related ills is not a license to abandon a healthy lifestyle. Doing so “could completely negate the benefit of a compound that slows aging,” he said.

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