Properly Estimating Older Friends and Colleagues

I learned, or perhaps relearned, something important today in relation to an older friend. He had been gaining weight and declining in his ambulatory status during the past 6 months or so. Yesterday I urged him not to walk to an overgrown area where I was walking because I felt that there were too many opportunities to trip and fall. However, today he chose to go there with me. He plodded a bit more than I, and he kept to the trails a little more, but he never seemed to be at risk for a fall.

There are lessons in at least two directions for this. One of course is that I was correct to look out for his welfare. The opposing lesson was that I should not legislate him away from taking a small risk. My friend is not frail. He can fall in a reasonable place and not get injured. And continuing to do the things that are important to him is very important in his continued viability in many dimensions. I have been thinking about continued challenge and exercise as one ages, and it appears to be even more important than I had thought. This is but one small example.

The Strength of Vigorous Aging

A friend of ours is a vigorous 88 and regularly plays tennis. She fell on her bicycle this August. She was going uphill, and those of us in the rolling hills of Massachusetts know how brutal that can be even for a college student. During the process her bike went slower and slower, and then she allowed the front wheel to turn and down she went. No ambulance. She got back up on her bicycle and proceeded home, a little hurt and a little shaken. We brought her some Arniflora, left over from fixing our child's pains when learning Tai Kwon Do. Our friend was sipping on an early cocktail when we came by. Some conversation and then we were off to our commitment. It is very good to have confirmed that not all falls, even from bicycles on the hard pavement of the street, are life threatening. They often do not even land a person under the care of a physician.

Single Payer Health Insurance

I was largely uninterested in this issue until recently, when a speaker at Harvard pointed out that the present health insurance system is broken. It is simple to see how it is broken: health insurance is for the most part attached to employers. This leads to huge liabilities for General Motors and other struggling or bankrupt companies. It also leads to expiration of coverage for individuals who lose their jobs. Now, I have worked closely with people at several Blue Cross/Blue Shield organizations, so I know the people and cannot accept that the source of the problem is corruption. However, it does appear that there is a problem, whatever the source.

The link here to BILL MOYERS JOURNAL on Single Payer Health Insurance will take you to one of the better discussions that I have heard about this topic. I am interested in your comments, and any other useful references on the topic.

Friends, Longevity, and Walking Revisited

I was talking with someone in his forties, a person who seems quite personable and outgoing. He told me that his wife and he are each others' best friends, and that each of them has about two good friends outside their marriage. It led me to think again about individual differences. I addressed personality and individual differences in my dissertation, so this will not come as a surprise to people who know my intellectual history. One key personality dimension is whether a person is a "reducer" or an "augmenter." Reducers are people who experience physical sensations less intensely than they really are. Augmenters are people who experience physical sensations more intensely than they really aer. Reducers tend to go into sports such as football, because it offers a means to feel they are really bumping up against the real world. Augmenters tend to go into activities that do not involve strong physical contact because it would hurt too much. Augmenters tend to achieve strongly in school, reducers less so. Reducers tend to have many friends, augmenters only a few. That being said, you can see where I am going with this.

It is unlikely that augmenters have a significantly shorter lifespan than do reducers. If you believe the life insurance companies, it may even be the reverse, because at least the last time I checked, they gave better rates for high school graduates who had strong academic records.

So this personality dimension also has to be taken into consideration when thinking about friend networks. The augmenters simply do not need or want as many friends. Reducers tend to have larger friend networks. So the material in my previous post has to be understood with a little more nuance than I first expressed it.

One way to think of it is in terms of augmenters who have relatively strong friend networks for augmenters, and reducers who have relatively strong friend networks for reducers. For each of these the observations might hold relative to those with weaker friend networks in each category. One might also argue that some augmenters do not need many friends, have very small friend networks, and so what! As long as they do not have an accident, they are just fine. But they are probably a pretty small part of the population. There are many more who would be better off for having a network of friends suitable for them.

A great research topic for somebody.

Friends, Longevity, and Walking

With the emergence of Girls from Ames, there is a newly acute awareness of the importance of social relations for health and longevity. We have known this about social relations within the family for a long time. I was personally introduced to this in the late 1970s by Stanley Krippner, an academic psychologist who studied cross cultural healing. One case example had particular impact on my thinking. This was about an elder woman from Central America who was near death. A native healer was called, and came to perform psychic healing. I recall that the healer claimed it was psychic surgery. This did not fool Dr. Krippner, who required that his graduate student study the art of magicians so that they could better understand sleight of hand. Stanley documented that indeed, the healer's performance was sleight of hand. Yet the elder recovered. So there must be some sort of dynamic. He concluded that it must have been the family members that the healer insisted bringing to the sick woman and the social interaction, the de-isolation, that led to the cure.

Now we have an article in the New York Times, http://www.nytimes.com/2009/04/21/health/21well.html?em=&pagewanted=print that presents some very compatible research results. A brief summary of research in the article identifies impacts of long term friendships on survival from breast cancer, reduced risk of heart attack and reduced fatalities from coronary heart disease, and reduced incidence of colds. One might ask whether this is alternatively a result of strong local relationships in addition to strong longterm relationship, that is, that people who have strong longterm relationships (at any geographical distance) also have strong local relationships, and it is really the local relationships that make the difference. The research is inconclusive, but the Times article seems to indicate that the longterm social relationships are actually more important than family relationships.

There is a line of unasked and unanswered questions that I pose about the question of whether such relationships extend to people's enduring capability to walk and run well. Frankly, I would bet that there is a relationship. Here is some introductory thinking about what the intermediate dynamics might be.

• People with good relationships would have a sense that life is worth living and in fact enjoyable, which would lead to continued physical vigor.
• People would enjoy and have fun walking in order to connect with their friends.
• People with friends would not give up, and thus would be better at recovering from injuries and problems.
• Such people would continue walking and maintaining themselves because they have something to live for. One of the problems of living into ones 90s is that many or all of one's friends pass away and one is left isolated. The solution to this is the development of new friendships, particularly with younger people. I have seen this occur when older people retain their mental aliveness and curiosity so that they are interesting to talk to. This again comes back to friendships.
• The ability to walk competently enables seniors to maintain relationships better and to continue to value them.
• Continued ambulation reduces the likelihood of depression and isolation, and these lead to continued ambulation. In some of what I have seen, loss of ambulatory competency results from not maintaining oneself. So friendships that reduce what leads to this will also reduce loss of ambulatory competency.
• In conclusion, lack of isolation, ambulatory competency, and linkage with friends are in many ways synonymous.

Possibly the most intriguing research finding in relation to this is summarized near the end of the Times article. Students wearing a heavy backpack were asked to estimate how steep a hill was in front of them. The students who stood beside a friend saw the steepness of the hill as being significantly less than those who stood alone in front of the hill. It would appear then that the task of walking up the hill, or for that matter, on a level surface if it is trying, is made more easy if one has the sense of the presence of friends. This would suggest strongly that friends make a difference for walking.

I am very interested in what others may have to say about this.

Calculator Gives Risk of Type 2 Diabetes

Type 2 diabetes poses a threat to the legs, and therefore a threat to walking. It is also associated with being overweight, which can also pose problems for walking. British scientists have recently found and published nine significant risk factors for Type 2 diabetes:

• age
• ethnicity
• body mass index
• smoking status
• socioeconomic level
• family history of diabetes
• diagnosis of cardiovascular disease
• hypertension
• use of steroid drugs.

They calculated the relative importance of each of these factors, and incorporated them into a web page algorithm, that quite accurately predicts the 10-year risk for Type 2 diabetes. Based on the British population, there is an interactive Web version of the algorithm at www.qdscore.org. Postal code and ethnicity applies only to Brits, but the results are good even without those two parameters.

See:
http://www.nytimes.com/2009/03/24/health/24awar0.html?src=linkedin

Electronic Monitoring

2/18/09: Last Friday there was a New York Times article about medical monitoring of seniors. It seemed to me that it reasonably summarized the current state of the art, although it left out some important names. I see our emerging technologies fitting right in with those discussed in the article. The point is to keep it simple and manageable for all involved, and to enable people to live out their lives as long as possible in their own homes. Here is a pointer to the article:

http://www.nytimes.com/2009/02/13/us/13senior.html