Prescription for Healthy Aging

By Danielle Aloia, Special Projects Librarian

September marks Healthy Aging® Month, a good time to evaluate your health. In the 1899 Good Health article “The Road from Life to Death,” Dr. David Paulson suggests that “the velocity with which men travel down grade toward ill health and death is largely regulated by themselves.” At any time a person can change deleterious habits and return to the road toward health. The worse your habits the harder it is to change course.1

From: Paulson D. The road from life to death. Good Health. 1899;34(8):481-482.

From: Paulson D. The road from life to death. Good Health. 1899;34(8):481-482. Click to enlarge.

In the diagram above Paulson describes certain stations as turning points. The “Business Pressure” station is marked by mental worry and sedentary habits. “Wretched Sanitation” refers to lack of fresh air and abundance of germs. The “Unnatural Demands of Modern Society” places blame on late hours and evening entertainment. The final station, “Intemperance and Dissipation,” is plagued by immorality, tobacco, and poor diet. Notice that at every station there is a “Reform” signal, a marker to let you know it’s time to make a U-turn toward health.

Even 116 years after the publication of Paulson’s article, we can still relate to the demands of each station. According to a 2013 CDC report, heart disease has been the leading cause of death since 1900, except during the influenza pandemic of 1918-1920.2 The authors offer a prescription: “Practicing healthy behaviors from an early age and getting recommended screenings can substantially reduce a person’s risk of developing chronic diseases and associated disabilities.”

It’s never too late to start living a healthier life. A list from 1954—which holds up well today—gives further specifics on how to make the switch to better health (if only we could all reside in temperate climates):3

From Walker, K. Living Your Later Years. New York: Oxford University Press; c1954.

From: Walker, K. Living Your Later Years. New York: Oxford University Press; c1954.

References

1. Paulson D. The road from life to death. Good Health. 1899;34(8):481-482.

2. The State of Aging and Health in America 2013. Atlanta: CDC; 2013:60. Available at: http://www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_2013.pdf.

3. Walker, K. Living Your Later Years. New York: Oxford University Press; c1954.

Aging Through Time

By Danielle Aloia, Special Projects Librarian

“Ah, but I was so much older then
I’m younger than that now”
– Bob Dylan, My Back Pages

May celebrates Older Americans Month, which this year focuses on promoting health and community engagement of seniors across the nation. Today, 14.1% of the U.S. population is aged 65 and older1 and by 2030, 20% of the population will be over 65.2 We are living longer, healthier, and more productive lives than ever before.

Over the years there has been investigation into aging and the life course, reflecting beliefs informed by the average lifespans of the time. The Art of Invigorating and Prolonging Life by William Kitchiner, published in 1821 in the U.K. and two years later in the U.S., suggested that life is divided into three stages, each stage requiring a different regimen of “food – clothes – fire – air – exercise – sleep – wine – &c.”3 Kitchiner cautions that people only realize the importance of these elements after they become enslaved to other, detrimental, habits. They may need to proceed gradually with his recommendations in order to correct the bad habits and form new ones.

The first stage of life is a period of preparation, from birth to 21. In this stage, people should take in as much healthful food as can be digested for the body to convert into Chyle (bodily fluids). The second stage, the period of active usefulness (ages 21-42), should include plenty of “hard exercise in the open air” to restore the body’s constitution. In the third stage, the period of decline, the rate of decline is based on the strength of the constitution built during the active stage of life. Without “due attention to Diet &c., the Third period of Life is little better than a Chronic Disease.”4

Pages 34-35 of Kitchiner, The Art of Invigorating and Prolonging Life, 1823 edition.

Pages 34-35 of Kitchiner, The Art of Invigorating and Prolonging Life, 1823 edition. Click to enlarge.

According to Kitchiner, by 42 years of age humans are on the decline; they are ancient by 63. Put in context, life expectancy in the 1900s for men was 46.3 in the U.S.and 44 in the UK.5,6 But still, Kitchiner believed it was never too late to make up for lost time.

Kitchiner incorporated William Jones’s andrometer,7 a chart intended as a tool for people to gauge their progress through life.8

William Jones' Andrometer, on pages 36-37 of Kitchiner, The Art of Invigorating and Prolonging Life, 1823 edition.

William Jones’ Andrometer, on pages 36-37 of Kitchiner, The Art of Invigorating and Prolonging Life, 1823 edition. Click to enlarge.

Unfortunately, Jones passed away in his late 40s and Kitchiner in his 50s. Sadly, neither got to experience “a glorious retirement” or the “universal respect” due after the age of 60.

More than 100 years later, in 1974, a new benchmark showed similarities to Kitchiner’s book while offering a 20th-century outlook. D. D. Stonecypher published Getting Older and Staying Young: A Doctor’s Prescription for Continuing Vitality in Later Life to give readers reliable and practical advice about aging, because “the quality of one’s later years grows out of the choices the individual makes.”9 In 1974 life expectancy in the United States was 68.2 for men and 75.9 for women.10

Stonecypher had specific audiences in mind for his work: middle-aged readers wondering about their aging bodies who may be modifying activities in order to preserve their vigor; older readers looking to gain insights into preserving mental and physical vitality; and younger readers who wished to assist the elderly and gain insight and perspective on their own aging process. He also notes another type of reader, the policy maker or community worker who “holds the key to the mounting social problems of aging.”

Stonecypher offered the following questionnaire as a way for readers to assess the probability of living a long life, but goes on to explain that medical science was advancing so rapidly it could be possible to double the life span to over 100 years. Citing that in classical Greece and Rome average life expectancy was 18 years, he writes that by the 1800s it had doubled to 35 years and between 1800 and 1970 it doubled again to 72 years.

In Stonecypher, Getting Older and Staying Young, 1974.

In Stonecypher, Getting Older and Staying Young, 1974.

In 2013, life expectancy in the United States was 76.4 for men and 81.2 for women,11 a substantial increase even from 1974. The longer one lives the more productive one may need to be: “a glorious retirement” may not be the answer to a healthy old age. Stonecypher tries to persuade his audience: “It is prejudice that has justified the compulsory retirement, inadequate pensions, the ostracism, and the other stresses which have come to seem a normal part of life after 65.”

This year, the Medicare, Medicaid and the Older American Act celebrates its 50th anniversary.12 The Act led to programs that have ensured access to health care, community services, and protections of the rights of elders. We have come a long way, but have even more work to do to support health and productivity of seniors as the population ages.

References

1. U.S. Census Bureau. State and County QuickFacts. http://quickfacts.census.gov/qfd/states/00000.html. Accessed May 21, 2015.

2. U.S. Census Bureau. An Aging Nation: the Older Population in the United States. Washington, D.C.: U.S. Census Bureau; 2014. http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_07.pdf. Accessed May 21, 2015.

3. Kitchiner William. The Art of Invigorating and Prolonging Life. Philadelphia : H. C. Carey & I. Lea; 1823.

4. Ibid.

5. U.S. Census Bureau. United States Life Tables, 2009.. Washington, D.C.: U.S. Census Bureau; 2014. http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_07.pdf. Accessed May 21, 2015.

6. England. Office for National Statistics. Mortality in England and Wales: Average Life Span, 2010. England: Office for National Statsitcs; 2012. http://www.ons.gov.uk/ons/dcp171776_292196.pdf. Accessed May 22, 2015.

7. Mental Floss. The Andrometer: an 18th-Century Measuring Stick for Success in Life. http://mentalfloss.com/article/58057/andrometer-18th-century-measuring-stick-success-life. Accessed May 21, 2015.

8. Jones, William. The works of Sir William Jones, Volumes 1-2, 1807. http://books.google.com/books?id=PW5KAAAAYAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false. Accessed May 21, 2015.

9. Stonecypher D. D. Getting Older and Staying Young. [1st ed.]. New York : Norton; 1973.

10. U.S. Census Bureau. United States Life Tables, 2009.. Washington, D.C.: U.S. Census Bureau; 2014. http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_07.pdf. Accessed May 21, 2015.

11. U.S. Census Bureau. Health, United States, 2014. Washington, D.C.: U.S. Census Bureau; 2014. http://www.cdc.gov/nchs/data/hus/hus14.pdf. Accessed May 21, 2015.

12. 2015 White House Conference on Aging. http://www.whitehouseconferenceonaging.gov/about/index.html. Accessed May 21, 2015.

A Lifetime of Healthiness? The Golden Health Library’s “Seven Ages of Man” (Item of the Month)

Cara Kiernan Fallon, this post’s guest author, is a history of science PhD candidate at Harvard University.

"The seven ages of man." From The Golden Health Library.

“The seven ages of man.” From The Golden Health Library. Click to enlarge.

Childhood can be full of “vigor and zest” but “Middle age is the time when our sins against the laws of health find us out,” warned physicians writing for The Golden Health Library’s inaugural volume. Published in the late 1930s, The Golden Health Library offered readers five volumes of advice on the “principles of right living” so they could secure health throughout their lifespans.1 Authors included physicians, nurses, professors, and even birth control advocates like Margaret Sanger. September, Healthy Aging Month, is the perfect time to revisit this publication.

Part of the New York Academy of Medicine’s extensive collection of health guides, public health pamphlets, and medical magazines, The Golden Health Library highlights the growing health concerns associated with longer lives and an emerging notion of the elasticity of health in later life. Although originally published in the United Kingdom, people on both sides of the Atlantic expressed concerns over health into old age as they were living longer than ever before. Between 1901 and 1931, the population over age 65 nearly doubled from 1.8 to 3.5 million in the United Kingdom, and went from 3 million to 6.6 million in the United States.2 Life expectancy at birth, a figure largely affected by infant and childhood mortality, grew dramatically along with the expanding older population. With more people surviving childhood and living decades longer, a new wave of health concerns—and health advice—came with it.

"Healthy womanhood." From The Golden Health Library. Click to enlarge.

“Healthy womanhood.” From The Golden Health Library. Click to enlarge.

"The wrestlers." From The Golden Health Library.

“The wrestlers.” From The Golden Health Library. Click to enlarge.

In a section directly addressing health throughout the life course—“The Seven Ages of Man”—The Golden Health Library provided a series of articles on maintaining health in each of seven stages of life: infancy, childhood, adolescence, maturity, middle age, elderly age, and old age. Physicians identified “the elderly age” as a “very elastic” time between middle age and old age (87). Rather than following an arc of growth to decline, “The Seven Ages of Man” presented the elderly age as an expandable period of potential health, one determined by physical condition rather than a particular chronological period. Men who followed the rules of health and hygiene, and who had “lived wisely…may feel justified in expecting to live for the full period of life free from disease… and to die of old age” (88). Moderate diet, exercise, rest, and regular medical examinations would also ensure a “healthy elderly age for all women—the best antidote to old age” (91).

"On skis at 63." From The Golden Health Library.

“On skis at 63.” From The Golden Health Library. Click to enlarge.

The idea of a healthy and elastic elderly age reflected important new concepts emerging in the 20th century. As people around the globe reached sixty, seventy, and eighty years of age in quantities never before seen, later life became a period of great diversity in physical, mental, social, and economic conditions. Readers were told that the “vigour and ability to do physical or mental work efficiently varies enormously in different people” but the “idea that advanced age in man must necessarily involve an arm-chair existence…is obsolete” (87, 89). Instead, it argued that “men are now never too old to lead an active life” (89). To demonstrate this new ideal, images of athleticism filled the pages of the elderly age. Fitness guru J. P. Muller was shown skiing in his undergarments at 63, and Lord Balfour was shown swinging for a tennis ball at the age of 80, both depicting the possibilities of health and vigor.

"Lord Balfour at eighty." From The Golden Health Library.

“Lord Balfour at eighty.” From The Golden Health Library. Click to enlarge.

Yet, the mid-century concept of a healthy elderly age also narrowly imagined health through a masculine body with physical freedom and strength. Despite women’s greater longevity—the article reminded readers that women lived on average five years longer than men at the time—the article offered no images of women living actively in the elderly age. Could no women be found to depict an ideal of healthy aging? Or did notions of health and age have different meanings for women than for men? Women may have been told they could achieve a healthy elderly age, but none could be found in these pages.

While the idea of healthy habits leading to a healthy older age offered a new optimism for the aging process, it also overlooked the powerful social and cultural influences on the biology, ability, and mobility of individuals. Recommendations throughout the lifespan for clean milk, sunny outdoor play, access to healthy foods, exercise, and regular physical exams reflected not merely physiological processes but more complex social and economic opportunities. Although the authors indicated that health throughout life was a matter of willpower, they acknowledged that few reached a disease-free old age. Were the ideals too lofty or were the challenges too great? Had their model failed to account for the complexities of health beyond a controllable regimen?

"A fine old age." From The Golden Health Library.

“A fine old age.” From The Golden Health Library. Click to enlarge.

“The Seven Ages of Man” offers an intriguing look into the early notions of healthy aging in the mid-20th century. While it responded to the growing population of older individuals, offering opportunities for self-determination and responsibility, it also reduced healthy aging to a matter of knowledge, willpower, and habit.

Decades later, efforts to improve the quality of life of older individuals continue to grow with the expanding population. Through its healthy aging initiatives and participation in Age-friendly NYC, the New York Academy of Medicine aims to address not only the physical components of aging but also issues of employment, housing, social inclusion, community health services, and many other social, psychological, and economic concerns for seniors. Looking back to The Golden Health Library allows us to explore the formative stages of important themes today – the growing belief in the elasticity of later life, the new emphasis on “healthy” and “active” aging, and the changing understandings of the powerful social and cultural influences on biology.

References

1. Browning, E., Stanford Read, C., Williams, L. L.B., Crawford, B. G. R., Arbuthnot Lane, W., Somerville, G. (193?). The seven ages of man. In W. Arbuthnot Lane (Ed.), The golden health library (pp. 48–96). London: William Collins Sons & Co. All parenthetical page numbers refer to this publication.

2. For the United Kingdom, see the Office for National Vital Statistics, Chapter 15 Population: Age distribution of the resident population, 15.3(a). For the United States, see the Center for Disease Control and Prevention, National Vital Statistics System, Population by Age 1900 to 2002, No. HS-3.