Richard G. Petty, MD

The Four Percent Solution

Posted by on February 20, 2006 · Leave a Comment 

In this week’s edition of the Journal of the American Medical Association, is a study of 11,701 American over the age of 50, who participated in a national health survey in 1998 funded by the National Institute on Aging. The researchers analyzed participants’ outcomes during a four- year follow-up and examined the health characteristics that seemed to predict death within four years.

These were the questions that were asked, and this is a bit like golf: you want to have the lowest score possible. Zero would be best. The score is supposed to tell you your chance of dying within the next four years.

1. Age: 60-64 years old = 1 point; 65-69 = 2 points; 70-74 = 3 points; 75-79 = 4 points; 80-84 = 5 points; 85 and older = 7 points.

2. Male or Female: Male = 2 points.

3. Body-Mass Index: Less than 25 (normal weight or less) = 1 point. (BMI = weight in pounds divided by height in inches squared, multiplied by 703.)

4. Diabetes: 2 points.

5. Cancer (excluding minor skin cancers): 2 points.

6. Chronic lung disease that limits activities or requires oxygen use at home: 2 points.

7. Congestive heart failure: 2 points.

8. Cigarette smoking in the past week: 2 points.

9. Difficulty bathing/showering because of a health or memory problem: 2 points.

10. Difficulty managing money, paying bills, keeping track of expenses because of a health or memory problem: 2 points.

11. Difficulty walking several blocks because of a health problem: 2 points.

12. Difficulty pushing or pulling large objects like a living room chair because of a health problem: 1 point.

Score:

  • 0 to 5 points = less than a 4 percent risk of dying;
  • 6-9 points = 15 percent risk;
  • 10-13 points = 42 percent risk;
  • 14 or more points = 64 percent risk.

So what should we make of this?

The first thing is that the study is just looking at the physical aspect of life. It asks nothing about diet or family history. It also says nothing about psychological and spiritual factors that can buttress health and well-being.

So what should it mean if somebody gets a high score? Does it mean that they should expect the end and stop reading long novels? Absolutely not! A high score should be a very good indicator that you should have a talk with your health care provider and get to work on all the reversible factors on the list. And as I have pointed out before, a positive psychological outlook and regular spiritual practice have been shown to extend the length and quality of your life.

It is not given to us to know the length of our lives and plenty of people live on and on despite breaking all the rules while others die young despite a lifetime of temperance. I had an aunt who smoked heavily throughout her adult life, yet lived to be well over ninety, while one of my former students died of lung cancer in his thirties, having never smoked a single cigarette.

Genes and lifestyle are important in determining our life span, but so are the quality and integrity of our relationships, our own sense of meaning and purpose, the clarity of the subtle systems of the body and our spirituality.

So use this study not as a death sentence, but as a wake-up call.

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Aging in Style

Posted by on January 10, 2006 · Leave a Comment 

It happens to all of us as we reach a certain vintage, that we begin to wonder how we will engage with and negotiate the inevitable process of aging. Billions of dollars a year are spent on trying to avoid the inevitable, and we are seeing people who have had not one, but layers of cosmetic surgery, botox and an array of other attempts to postpone or camouflage the effects of the passage of time.
For over two decades Andrew Weil has been one of the most sensible voices in the field of whole-person medicine, and he has recently turned his attention to aging, driven in part, as he says, by himself passing age 60 in 2002. His latest book Healthy Aging is full of common-sense ideas and is well worth reading. His approach to healthy aging was described in an article in the Washington Post by Agigail Trafford.
In a nutshell: Learn to breathe deeply, eat fruit and vegetables, walk, dance, play golf, do yoga, develop a positive mental attitude, learn a second language, get a massage, put fresh flowers in the house, be sure to love, and pay attention to spiritual health. He also makes another point, which is brought out in the Washington Post article, but has not been in many of the other reviews of the book. Weil is firmly of the view – as am I – that there has been altogether too much emphasis on personal responsibility for poor health choices, and not enough on an individual’s genetic predisposition to some problems, like obesity, as well as social and environmental pressures. As a "for instance," there has been a chronic lack of governmental and corporate will to improve the quality of food or to encourage exercise. Though I think that this was written before the Department of Agriculture’s new initiatives on healthy living, which are making bold, if belated, attempts to improve the quality of life of people not just in the United States but around the world. And Weil points out that many Departments of Government have a part if we are to improve the prospects for healthy aging.
It is difficult to disagree with any of these things. But I have two nagging worries about his book, though to be fair, I suspect that he would agree with me about both.
The first is that what he proposes is mainly something for the relatively affluent classes. Although I have no problem with a counsel of perfection, I wonder how realistic are his plans. I have spent years trying to help people in the most deprived circumstances, and for many of them, the prospects that they will be able to find or afford healthy nutrition are scant, and even walking outside may be dangerous. That is, of course, why we need corporate and Government help.
The second point is about acceptance: accepting the passage of the years with grace, serenity and equanimity, instead of fighting the inevitable. Of accepting that increasing age can be a time of deepening spiritual insights and of the progress growth of understanding and wisdom. I know that is Weil’s position, and it comes up in the later stages of his book, but I would hate to see such an important aspect of healthy aging lost in the rush to try his sage advice about diet, sleep and supplements.
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