Age when the Wit is Out

old musician

Death has become an acceptable and even a fashionable topic.  Conversations about death are becoming speculations about the amenities of bland final visits to Holland or Switzerland. Very soon, as entrepreneurs recognize and grasp the rich opportunities, such cosy suburban deaths will be only the economy-end of a spectrum  of choices stretching to deluxe departures, precisely timed at sunrise or sunset in mountain, woodland or tropical beach locations with optional champagne, vintage brandy, succulent canapes, background music of choice, professional recording of last words and terminal selfies. We are becoming Cool about Death, but  are not yet de-sensitized to a much more disturbing issue:  Before we can splash out our savings  on a Premium Last Passage we may become demented  and a pitiful burden to ourselves and any who care for us. What are the odds of such disasters and can we do anything to tilt them in our favour ?

All studies agree that our chances of our escaping dementia are much better than we might fear. The most common dementia is Alzheimer’s disease (AD) a neurodegenerative condition with brain changes including characteristic patterns of progressive nerve-cell deaths associated with changes in protein metabolism and, on microscopic  examination of the brain marked by scar-like plaques and “neurofibrilliary tangles”. These  first appear in the neocortex  and eventually spread to the hippocampus. Another neurodegenerative condition, Pick’s Disease, or Lewy Body Dementia is, happily, much less common. After neurodegenerative conditions the most common dementias are associated with problems with brain blood supply, such as ruptures and blockages of tiny blood vessels causing deaths of small areas of brain tissue that they serve. Like the risk of AD the risk of such Vascular Dementias  increases with age.   A very large 1994 Canadian Study of Health and Aging [ 1 ] found  that overall incidence of all kinds of dementias was 23% for  those aged 85 to 89 and increased  to 40% in a 90-94 year old group and 58% in a relatively small group who were over 95. Over all age-groups AD accounted for 75% and vascular dementia for 13% of  all dementias.  Incidence of AD cases increased faster than of Vascular Dementia cases after  65 and was higher in the 85+ group than in those aged 65 to 85. It is useful to remember that these numbers refer to survivors in each age group. This means that most people in this, and all other populations die without experiencing dementias. The amount and quality of comfort you get from this thought will depend, of course, on your personal  views on life and death. I find it rather cheering.

What factors increase risk of these obnoxious conditions and what can we do to improve our chances of avoiding them?  Analyses comparing results of many studies suggest that the Canadian figures are quite typical because the  risks of dementias do not much differ between countries [2]. As these show, the risk of dementias markedly increases with age. Some analyses combining data from several studies suggest that this accelerated increase in risk with age slows down in the late 80’s and 90’s but other surveys find a linear increase continuing after 85. Diagnoses are sometimes uncertain because brains of older people who experience only very mild mental declines, often called “Mild Cognitive Impairment”  often show AD-like changes in nerve cells. On the other hand Mild Cogntive Impairment is a strong risk factor for future AD and other dementias. A different neurodegenerative dementia, Pick’s Disease, or “Lewy Body Dementia”  is relatively rare,  and so less well documented, but is also age-related. Probably a more common neurodegenerative  dementia than Picks associated with  Parkinson’s disease, in which it is certainly not an inevitable outcome but affects about 40% of sufferers [3].

As these numbers suggest the strongest risk factor for all dementias is getting old. The reason for the  increased incidence of dementias,  melodramatically described by the media as an “epidemic” or “plague”, is not that they are contagious or are becoming more common at any particular age but just that more of us now survive to experience them. A crucial comfort is that in this context “Age” is not the remorseless tally of our birthdays, “Calendar Age”, but “Biological Age” the amount and rate at which our bodies and brains have changed and how fit we still remain.  The check-list of risks is almost identical for both Alzheimer’s and Vascular Dementias because most factors that impair well-being increase risk of both.  One exception is that a genetic factor, apolipoprotein e4-allele seems to increase risk of AD and, in particular, increases the risk from all other unhelpful lifestyle factors. Smoking is very bad news, as is being fat, especially if we have put on weight during or before middle age and not slimmed down since. Nevertheless even elderly long-term fatties should never surrender the struggle to lose weight because this still significantly reduces risks. Diabetes increases the risk of all dementias [4] and so, most definitely,  does cardiovascular disease and taking little or no exercise. The incidence of AD is greater in women than in men but there is encouraging evidence that this is not the case in women who have had Hormone – Replacement Therapy for at least 10 years.

We have all become weary and disheartened at being continually nagged to take more exercise because, apart from not smoking but this is probably the most effective thing we can do to extend and increase the length of our lives and our daily pleasure in them. We need aerobic exercise that benefits our hearts and lungs and so the blood and oxygen supply to our brains but it is surprising, and to me profoundly encouraging  how very little exercise can make a difference.  For example a useful study found that incidence of AD in a 3 year period was significantly less in elderly who walked 2.0 miles a day compared to 0.25 miles a day and even the lower mileage gave a slight but real advantage over total torpor. Another reassuring study [5] found that even gentle activities such as doing odd-jobs about the house, gardening and generally pottering about reduced the risk relative to that of deep inertia. It is mean to be a spoilsport about such a congenial result. I, for one, deeply wish to trust it  but there is a small problem of participant selectivity: was pottering the cause or only a symptom of relative preservation in those who  were chosen for assessment?   Had those who could not even potter around a bit already crossed a frontier from which they could not return?

Academic colleagues are smug to learn that longer education lowers the risk of Alzheimer’s and other dementias. There is the usual problem of interpretation because longer education tends to buy a more comfortable life in non- toxic environments with better diet and more attention to health care and so lower risk of pathologies such as cardiovascular problems and diabetes that are risk factors for dementias of all kinds.

It is difficult, and perhaps even gauche to scrabble for a cheerful note on which to end a post on dementias.  Studies of alcohol consumption probably provide the only glint of amusement we can wring out of this cheerless topic. A very large, and apparently well-conducted study in the Dordogne found that consumption of even 5 standard glasses of wine a day did not increase risks of dementia and that men and women drinking smaller amounts had slightly lower risks than tee-totalers. Convincing studies based in  Copenhagen [6] and in Rotterdam [7], where wine production is not a significant part of the economy, found that modest daily consumption (1-2 glasses) of beer and spirits had no bad effects, and that drinking modest quantities of wine actually reduced risks. This inspires me to a new life plan: whenever anxiety that I may soon dement peaks to the point at which I must take action I shall avoid my nearest bottle-shops and manfully step out to the furthest that I can reach and buy as good a bottle of wine as I can afford. Beaujolaise  if they have it.

  1. Ebly, E. M., Parhad, I. M., Hogan, D. B., & Fung, T. S. (1994). Prevalence and types of dementia in the very old Results from the Canadian Study of Health and Aging.Neurology44(9), 1593-1593.
  2. . Fratiglioni, L., De Ronchi, D., & Agüero-Torres, H. (1999). Worldwide prevalence and incidence of dementia. Drugs & aging15(5), 365-375.
  3. Emre, M. (2003). Dementia associated with Parkinson’s disease. The Lancet Neurology2(4), 229-237.
  4. Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitis: A systematic review. Lancet Neurol. 2006 Jan; 5(1) 64-74
  5. Fabrigoule, C., Letenneur, L., Dartigues, J. F., Zarrouk, M., Commenges, D., & Barberger‐Gateau, P. (1995). Social and leisure activities and risk of dementia: a prospective longitudinal study.Journal of the American Geriatrics Society,43(5), 485-490.
  6. Truelsen, T., Thudium, D., & Grønbæk, M. (2002). Amount and type of alcohol and risk of dementia The Copenhagen City Heart Study.Neurology59(9), 1313-1319.
  7. Ruitenberg, A., van Swieten, J. C., Witteman, J. C., Mehta, K. M., van Duijn, C. M., Hofman, A., & Breteler, M. M. (2002). Alcohol consumption and risk of dementia: the Rotterdam Study.The Lancet359(9303), 281-286.
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Living (nearly) forever

alcohol

Even for Aging Studies August is the Silly Season.  What people really want to be told about old age is how to avoid it entirely or, paradoxically, how to prolong it indefinitely by putting off dying as long as possible. Hence a babble of late-summer-feel-good advice in Newspapers and Twitter on how we may manage this.

My favorite in this  summer harvest of feel-good stories  is a new recycling of the hoary anecdotes  so often told about apocryphal relatives or acquaintances who lived to a remarkable and rumbustious old age by ignoring temperate behaviour.  Agnes Fenton, of Fenton, New Jersey, believes that she reached 110 on August 1 st this year because, for the last 70 years, she has drunk at least 3 pints of Millers High Life Beer and a shot of Johnny Walker Blue Whisky every day. The site, drinkaware.com, sponsored by Koparberg Premium Cider of Sweden, adds comments by Dr Jiangou Fang, of Lanzhou University  on an article in the Journal of Agricultural and Food Chemistry suggesting that regular beer drinking may stave off Parkinson’s, Alzheimers and other dementias because hops contain a benevolent flavonoid, xanthohumol.  This is excellent news for those of us scrabbling for reasons to trust the increasingly dicey evidence that copiously drinking red wine may also prolong life and benefit the aging brain.

chillies

Another encouraging Chinese study published on 4 August 2015  (BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3942 ) found that in samples of 199, 293 men and 288, 082 women aged 30 to 79 ( excluding participants with cancer, heart disease, and stroke at baseline) people who reported  eating spicy foods on 6 or 7 days a week showed a 14% reduction in mortality compared  to those who ate them on 1 day a week or less. A gratifying detail is that the benign interaction between  spice and  longevity  is stronger in people who also drink alcohol. Though the interaction between the effects of alcohol and spice, at p = .03, is not as robust as we would wish this is still an encouragement for British Males who can now claim that their traditional pungent Curry Dinners following evenings in pubs are not a luxury but an essential regimen for body and brain maintenance.

A slightly less encouraging finding  by Danxia Yu and 10 others, (PLOS  Med May 26, 2015) comes from their study of the effects of very faithfully keeping to a diet based on the US Dietary Guidelines for Americans. Between 2002 and 2009 among 84,735 persons, with below average incomes,  aged from 40 to 79, who were citizens of the 12 South Eastern States of the USA.  fewer of those who rigorously kept to the diet died. This is interesting information but, given the wide difference between junk-food  and the US Guideline Diet, perhaps not surprising. For a cognitive gerontologist there is also the issue whether individuals who were sufficiently motivated and steadfast to maintain the Guideline Diet were not also different in important ways from those who could not do so. Comparisons of obesity in the two populations would also be useful.

Keeping to a sensible diet can be difficult, especially if you are poor. However meditation and looking on the sunny side of life are available, free, to all of us. Scores of recent articles  insist that cheerful and positive people live longer and so retain their mental abilities later than the morose or miserable. This tells us  little new because there are many reasons for being more morose than average: among these are socio-economic disadvantage and illnesses that also shorten our lives and speed mental decline. Similar problems apply to the many  studies  showing that people with high youthful scores on intelligence tests are likely to live longer than their less able peers. These are particularly encouraging to self-satisfied academics but we must remember that higher intelligence buys many things. Among  these are greater affluence and so better medical care, a more salubrious lifestyle and environment,  better education in healthy living and choice of diet and even perhaps more and better wine, beer, whisky and curries.

The August  prize for the best advice on how to live  (nearly) forever must go to a story giving cutting edge scientific credence to a sanguinary medieval aspiration. Many sources, including the Guardian (Aug 4, 2015) comment on a paper in Nat Med 2014 (6) 659-63 by S.A. Villeda and 17 others claiming that “ Young blood reverses age-related impairments in cognitive function and synaptic plasticity in mice”. This has a titillating range of historical resonance: from  lethal C16 th to C18th experiments in transfusion of blood from young to elderly humans, through C19 overtones of Vampirism, to warnings by C20 Science Fiction writers that visions of capitalists draining the lifeblood of the poor may transcend metaphor to become  horrid reality. With added revivals of Medieval speculations that not only the age, but the quality of the fluid is crucial. I hope that my GP takes note and  eagerly look forward to being prescribed at least two litres of Extra Virgin a week. As soon as our National Health Service  gets its act together.

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New possibilities for Old Academics

The long hours between Lunch and Gin are enlivened by a new excitement. When I was young I timidly offered articles and book proposals to supercilious journal editors and publishers who, mostly, rejected them. Now that I am old and unproductive publishers  e-mail blandishments to contribute “invited” articles on Urology, Quantum-Mechanics and  Neurophysiology to “field-breaking” journals that “will provide an appropriate setting for my distinguished and important work”. I have even been offered Associate Editorship of a “mould-breaking (sic) International Journal of Gerontological and Geriatric Studies”.

A vestige of a  striving former self dating from somewhere between 1963 and 1968 gibbers from his decaying grotto in my cortex that seizing such succulent opportunities might have persuaded his employers to take him seriously, to extend his contract beyond the minimum that MRC allowed and ease him into a career far more glittering than the one we actually managed. (His moans “Too late! Too late” echo the  snideness of our cleaning lady, Lavinia, about my rusty exercise bike). The clapped out current-self now in charge of my life mumbles that the journals seem to be new ventures by unknown firms in Madras, Beijing and Singapore, that we do not recognise any of the  Editors or Board members and that, although though I have nearly finished reading each of three paper-backs on Quantum Dynamics for Dummies it may be too soon to submit “Speculations on consequences of collapsing the quantum probability function for slowing of decisions in Old Age”, even for “guaranteed immediate publication”. Clearly these people know  and care as much about me as much as do warm-hearted Nigerians who salute me as a  Brother in God and offer to deposit astounding sums of $US in my bank account.

But today is different (as today always turns out to be). An e-invitation from a respectable publishing firm for whom I have often produced work offers me a chance to do something that I might still, actually manage!

“Given your expertise in this field, we would be absolutely delighted if you would agree to produce a video for our Psychology Video Collection, to be released in March 2016. We notice that you were the lead contributor on the following concept published in the Encyclopedia of the Mind edited by Harold Pashler in 2013:

Aging Memory and Information Processing Speed

Might you be interested in creating a video discussing this concept in your own words?”

Well ! How very, very nice!  Not just slog out yet another grey typescript but  re-cycle MY OWN WORDS and speak them, with accompanying smirking, and possibly even some modest prancing and posturing, sharing my trove of wit and wisdom about Geriatric Reaction Times with the eager young ! Who knows where this may lead? Breakthrough to a personal BBC TV slot on “Slowing of Information Processing in Old Age” seems an implausible fantasy but being recognized in the street by charming young people warmed by a winsome introduction to the wonders of The Brinley Function might, surely, plausibly happen? Even once or twice would be very nice?

So: To the meat of the deal:

“We’re keen to receive videos by October 16th  at the latest, so we’d be very grateful if you would confirm your interest as soon as possible — but please do ask if you have any questions! Please feel free to simply reply to this email if interested.  We will receive your response! “

Undertaking to reply to my response would have been more reassuring but of course I immediately clicked to a new screen where my questions were answered:

  1. The publisher will retain all copyrights.
  2. The publisher will give no help with preparation of the video (though presumably, if they are wise, they will wish to rigorously edit and demand revisions of submissions).
  3. “Unfortunately” there can be no guarantee that institutions or funding bodies will find these productions evidence of merit when comparing candidates for tenure, promotion or support.
  4. The deadline is inflexible.

Like all deadlines it seems at first to be comfortable eons away – at the end of what my generation of academics used to call “the long vacation”. Though I am no longer employed I estimate that, because I am now slow and  have no technical back-up,  writing a transcript of a course, making a video and editing and re-editing these to satisfy a publisher’s  production team would  take me about 200 hours.

  1. I will be paid nothing but I will get to keep and use (with  some stringent restrictions) a copy of my transcript and video.

The publishers are clear and honest about their proposition but why do they think that I might go along with it? Perhaps, as with  incredible Nigerian offers the crafty strategy is to locate uniquely credulous persons who are  the most likely to become malleable contributors?  Have I been fingered as an old fool who now has more spare time and frustrated vanity than common sense? Maybe; but I imagine that similar proposals will go to young people who are still very active in research.

Ever since Grub Street a haughty response used by firms of publishers to put down authors is that they are not mere commercial enterprises. They are far sighted, energetic and warm-hearted professionals who take up the huge task of  knowledge-dissemination without which Science could not progress. They strain their generous hearts and keen commercial brains to benefit underpriveledged students in universities that cannot afford to buy runs of their (grossly overpriced) journals or to pay competent lecturers to design and give courses. They propose to do this by marketing compilations of selected papers and, now, entire courses of canned video-lectures. Crusty superannuates may begrudge  a few hundred hours to share their fading  knowledge with some of the neediest students in the world. Some, like myself, may even grumble at writing journal articles for nothing or resent paying serious sums to get them considered by other experts who are paid nothing for this trouble, or carp at reviewing other peoples’ articles for free or  demur at unpaid editorial jobs processing scores of Ms. and oversee production of the journals in which they appear. Selfish shirkers just do not get the point that without contributions of our surplus time publishers simply could not afford to do the wonderful job that they do (e.g. Elsevier’s annual profits are barely more than 30% of their gross turnover).

We cannot blame academic publishers for making strange suggestions – only ourselves for tolerating an environment in which they seem normal. Unless results and arguments can be made available to as large a community as possible to be checked, developed, and to become part of a global culture there can be no science, or only very small and very slow science. Do we really need publishers for this? As the soubriquet suggests “Academic” publishers were essential when most scientists were “University Academics” but we have since passed two different historical cusps: First, transmitting what we know no longer depends on skilled management of a chain of complex processes beginning with the destruction of trees by heavy machinery. Second, up to 70 of working scientists are no longer “Academics” in Universities that strive to find ways to grade our achievements so that they can reward, tolerate or dismiss us – and use counts of citations of papers in “academic journals” as the least-bad metric to do this.  Most  do their research in Industry or in other kinds of institutions that have developed sophisticated means of internal and external dissemination of knowledge. Mathematicians and statisticians can personally post their results digitally, time stamped to establish priorities. A cheap desktop computer can share all  we know with anybody in the world. Retired academics no longer have to maintain support by University Departments by notching “citation counts” or  other “productivity indices.” We are free to samizdat  our own collections of digital papers, lectures, and even instructional videos,  publicise them on easily usable  public forums for virtually no expense and  give them, free, to any who may find them useful. For sure this takes time, – which we have in abundance – and energy – a much scarcer commodity. Nevertheless I promise you, from my small personal experience, this is far more fun, and results in personal interactions that are much warmer and more rewarding than the tepid transactions  we have had, throughout our working lives with  huge prosperous institutions that we have labored to support.

For a much more detailed analysis of the problems and new possibilities of academic article publishing in the digital age please see

http://deevybee.blogspot.co.uk/2015/05/will-traditional-science-journals.html

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Driving risks and old age.

Tortoise with prosthesis

 

Sheila Hancock, an actress who has given pleasure to thousands for decades, is a veteran motorist who has driven for 60 years, has had no driving accidents for which she was to blame and so has made no insurance claims. The Admiral Insurance Company celebrated her 82nd birthday by raising the premium for her 3-year old mini-Cooper from £873 to £ 2,246, i.e. £ 1373 in a single year. She shared her outrage with the Guardian Newspaper who researched actuarial statistics showing that, on average, claims by drivers aged from 18 to 20 average 67%, from 46 to 50 66% and from 76 to 80 65% of the premiums that they pay. Accident rates are highest in the teens and twenties, lowest in middle age rise only very slightly during the 70’s. So that these equalities mean that, from our 2nd to 7th decades insurers vary our premiums according to our projected accident costs. After age 80 these reassuring equalities break down. Surprisingly for those still driving in their 90’s insurers’ accident-cost/premium ratio drops to 52% so that insurers make 13% to 15% profit from nonagenarians than from teenagers. The Guardian quotes no accident cost/premium ratio for 80 year olds but, irrespective of car-type or claims history, it seems that an average 82 year old pays £392 while an average 62 year old pays £286 and this difference is increasing. During the past year average premiums have risen by £35 for 80 year olds but dropped by £50 for teenage drivers. Do sharp declines in driving competence in the late 70’s and 80’s justify this? Accident statistics show only a very slight rise in reported accidents between 70 and 90. This is not completely helpful when comparing claims costs that may reflect different kinds and numbers of accidents which may be more to less expensive for insurers.

Another difficulty is that as populations age so decade-group averages become increasingly poor indices of ability. In spite of clear everyday evidence we tend to ignore the blatant fact that variability in competence between people increases with group age so that differences between the least and most capable markedly widens. The most able 70 year olds in the UK are still running industries, steering politics, writing excellent novels or scientific papers or, like Ms Hancock, giving delightful performances but between 30% and 45% percent of their co-evals need sheltered accommodation or full-time care. In our Manchester longitudinal study a dwindling number of volunteers showed little or no measurable changes in mental ability as they aged from 65 to 85 but increasing numbers of their less fortunate peers suffered illnesses such as cardiovascular problems and diabetes that caused rapid losses of competence and earlier deaths [1,2]. We must expect that as motorists age a diminishing few will remain competent through their 60’s, 70’s and even in their late 80’s or 90’s, but an ever increasing majority will become at risk. Are there more convenient and fairer measures than accident statistics to discover motorists who are becoming risky so that they can give up driving before their increasingly probable accidents happen ?

My personal research on some problems of older drivers showed me that trying to answer this question is not only very hard but can get one into highly emotional discussions. Pragmatic traffic policemen saw me as a deranged scientist recklessly keen to unleash hordes of grey slayers. Older motorists saw me as a callous age-traitor, keen to snatch away their small joys and freedoms. How to recognize unsafe elderly before they cause damage? My favorite anecdote, to hint that this might not be easy, was that during most summers newspapers print stories of elderly drivers who bravely set out from their homes and are discovered, a day or more later exhausted and dehydrated in some distant part of the country. Obviously they were at grave risk while they were lost and bewildered, and we might well advise them to give up driving. But…….. We must nevertheless recognize that they have driven for very many hours and miles, often in a state of terminal fatigue, and without causing an accident. One explanation is that perceptual and motor “driving skills” sometimes seem to survive gross confusions of higher order thinking. Another is that the vigilance and competence of other road users makes the driving environment more forgiving than we usually suppose. (Current easy availability of GPS and other in-car navigation systems is probably not a good solution for such unfortunate geographical derangements because, as motorists grow older they have greater difficulty in attending to two things at once. This not only makes them uncertain in heavy urban traffic and at busy intersections [3] but particularly confuses them if they try to simultaneously drive and follow a GPS [4]). Road traffic policemen and other experts were generally unsympathetic and countered my tales of accident– free driving by deeply confused elderly with accounts of roadside checks that pick up oldies who, even when wearing their spectacles, are so visually disabled as to be almost blind. My ripostes with data from elderly motorists in Marin County California who responded to visual difficulties in a timely way in spite of great personal inconvenience seldom cut any ice [5] If people cannot recognize that being nearly blind puts them at risk how can we trust them to become aware of their more subtle problems?

There is a huge literature on when and why people give up driving. A 1995 U.S. study of the driving expectancy of 4699 motorists aged 70 and over [6] found that those aged from 70 to 74 could expect another 11 years of driving, often terminated only by their deaths but also by voluntary withdrawal. In a typically thorough 1992 Finnish study [7] all license holders born in 1922 were asked how and why they had decided to stop or continue. The main reason for stopping was poor health, though most also reported increased driving stress. All but 6.9% of those who had given up said that they had done so without advice from family, friends or medics. Like all other surveys this study also found that withdrawal from driving is not an abrupt decision but a gradual process. Older drivers gradually drive less, year on year, and become increasingly selective about the times of day and the routes on which they drive until they discover that even reducing difficulties in this way is not enough, and give up completely. A key point is that this self-modification of driving behaviour does, in general, seem to work very well. The numbers of accidents for older drivers who maintain a high mileage are equal to, or less than those of their peers who now drive much less [8]. Clearly self-monitoring is effective, and people know when they are still safe and when they are beginning to be at risk. Recognition of driving stresses alters their behaviour until they finally stop driving, in spite of the strong temptation to give themselves the benefit of the doubt. Giving up driving is hard, particularly for men, who tend to feel that a car is essential for more aspects of their lives than women do and people living in rural areas may have very little access to other forms of transport to manage their daily lives. US studies have found that having to give up driving greatly attenuates the lives of both men and women by shrinking the already sparse range of out-of-home activities that remain possible for them [8]. This difficult decision can be eased by provision of check lists such as the “Driving decisions Workbook” [9] or the Manchester Driver Behaviour Questionnaire [10] which, by probing their memories of difficulties they have encountered in various driving situations can help them to become more clearly aware of their problems – or, indeed, to relieve them of anxieties and more cheerfully plan their remaining driving careers.
So, rather than simply stopping people from driving at some determined age or waiting for them to disqualify themselves can we find “gold standard” tests that will identify older drivers who are becoming risky ? A study of 1910 elderly drivers by Karlene Ball and colleagues [11] found that among individuals with adequate vision, being older, being a man, having a history of falls, having poorer scores on a behavioral test of frontal lobe function (the “trails test”) and on a complex test of attention (Ball’s useful field of view test) all predicted future risk of self-at-fault crashes. Most other studies roughly agree with at least some of these findings, but there is a growing consensus that health problems and the biological changes accompanying old age are even more powerful predictors. Reading about Ms Hancock’s confrontation wither the Admiral Insurance Company made me re-visit data gathered and published many years ago on a sample of 555 gallant Manchester volunteers who not only took a battery of more than 50 different physiological and mental tests but agreed to be evaluated, while driving their own cars, by experienced driving instructors (see, for instance, [10] and other papers by the same authors). The conclusions, given below are from an exceptionally thorough re-analysis of this data-set by Mei Foong Low [12]. As in other analyses of this data set Mei Foong Low found that quite simple biological indicators such as strength of hand-grip or the maximum force of leg-thrusts and a measure of lung capacity did significantly predict both whether or not individuals has experienced any accidents during the last 5 years and how many accidents they had experienced. The new twist was that if drivers’ self -reports of all illnesses with which they had been had been diagnosed were also taken into consideration predictions from grip strength, leg-thrust and lung capacity were greatly weakened or disappeared. This suggests that these rather arbitrary and peripheral measures of well-being mainly pick up differences in general health status and wellness that are more basic determinants of driving skills. Among other significant predictors were peripheral vision, hearing, balance, joint flexibility and of decision speed and attention, including the tests of attention and of frontal lobe function included in the study led by Karlene Ball. Though, in our study, neither Ball’s test of frontal function (the Trails test) nor her test of attention (The Useful Field of View test) significantly predicted frequency of accidents, two of our other tests of attention and decision speed did. However the catch was the same as has been found in her study and in all of the others that I have read. While statistical tests confirm that associations between peoples’ scores on some tests test scores and their accident records are significant, in the sense that they are much stronger than we would expect to happen by chance, no test, or measure, or combination of measures has accounted for more than a very small amount of the huge variability between individuals. In fact even our” best” tests accounted for no more than 2% of the total variation in accident records between people. In short, within a very large group of people those who had poor test scores were indeed more likely to have had accidents the power of this prediction was so low that it would not be sensible or fair to make decisions about whether particular individuals were at risk only on the basis of their test results. Among many possible reasons why they are such weak predictors is that the vast experience of driving that individuals gain during their lifetimes compensates for other declines in their mental and so emerged in Mei Foong Low’s exceptionally thorough analyses as a significant predictor of their accident records.

I would love to encourage the scintillating Ms. Hancock in her confrontation with her insurers by giving her numbers to persuade them that because we are all so very different from each other, and because these differences increase as we age, it is grossly unjust to lump all of us into very rough categories so that the most able and harmless of us can subsidize the costs of the more dangerous. I am sure that this is the case, and that more effective and equitable means must and can be found. I am very sorry that this is not yet, and certainly not by me.

1. Rabbitt, P., Lunn, M., & Wong, D. (2006). Understanding terminal decline in cognition and risk of death. European Psychologist, 11(3), 164-171.
2. Rabbitt, P., Lunn, M., Pendleton, N., & Yardefagar, G. (2011). Terminal pathologies affect rates of decline to different extents and age accelerates the effects of terminal pathology on cognitive decline. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 66(3), 325-334.
3. Ponds, R. W., Brouwer, W. H., & Van Wolffelaar, P. C. (1988). Age differences in divided attention in a simulated driving task. Journal of Gerontology, 43(6), P151-P156
4. Dingus, T. A., Hulse, M. C., Mollenhauer, M. A., Fleischman, R. N., McGehee, D. V., & Manakkal, N. (1997). Effects of age, system experience, and navigation technique on driving with an advanced traveler information system. Human Factors: The Journal of the Human Factors and Ergonomics Society, 39(2), 177-199.
5. Brabyn, J. A., Schneck, M. E., Lott, L. A., & HaegerstrÖM-Portnoy, G. (2005). Night driving self-restriction: vision function and gender differences. Optometry & Vision Science, 82(8), 755-764.
6. Daniel J. Foley, Harley K. Heimovitz, Jack M. Guralnik, and Dwight B. Brock. Driving Life Expectancy of Persons Aged 70 Years and Older in the United States. American Journal of Public Health: August 2002, Vol. 92, No. 8, pp. 1284-1289
7. Hakamies-Blomqvist, L., & Wahlström, B. (1998). Why do older drivers give up driving?. Accident Analysis & Prevention, 30(3), 305-312.
8. Langford, J., Methorst, R., & Hakamies-Blomqvist, L. (2006). Older drivers do not have a high crash risk—A replication of low mileage bias. Accident Analysis & Prevention, 38(3), 574-578. Marottoli, R. A., de Leon, C. F. M., Glass, T. A., Williams, C. S., Cooney, L. M., & Berkman, L. F. (2000). Consequences of driving cessation decreased out-of-home activity levels. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55(6), S334-S340.
9. Eby, D. W., Molnar, L. J., Shope, J. T., Vivoda, J. M., & Fordyce, T. A. (2003). Improving older driver knowledge and self-awareness through self-assessment: The driving decisions workbook. Journal of safety research, 34(4), 371-381.
10. Parker, D., McDonald, L., Rabbitt, P., & Sutcliffe, P. (2000). Elderly drivers and their accidents: the Aging Driver Questionnaire. Accident Analysis & Prevention,32(6), 751-759..
11. Ball, K. K., Roenker, D. L., Wadley, V. G., Edwards, J. D., Roth, D. L., McGwin, G., … & Dube, T. (2006). Can High‐Risk Older Drivers Be Identified Through Performance‐Based Measures in a Department of Motor Vehicles Setting?.Journal of the American Geriatrics Society, 54(1), 77-84.
12. Mei Foong Low (2003) Assessing the Association Between Cognitive and Physiological Measures and Car Accidents among Older drivers. MSc thesis , Department of Statistics, University of Oxford.

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Multiple Intelligences in Old Age:Where did the Spin Begin?

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My last 60 years in cognitive gerontology have been very happy and interesting but this long perspective has drawbacks. New researchers recycle confused old ideas and new journalists enthusiastically spin their muddles. A well-conducted and analysed study by Hartshorne &  Germine [1] again assures us that, as we have known for 70 years,  our scores on simple problems of the sort used in “intelligence tests” [2] peak in our mid- twenties and then decline. This is not the best possible news but panic is unnecessary because these losses are small and slow [3]. Also throughout our lives we continue to learn useful new skills that we can practice and keep in old age [4]. Hartshorne and Germine try to cheer us up further with reliable new data which, they claim, shows that we have different kinds of intelligence and that only some of these fade early while others are ripe autumnal fruits of maturing minds.  I should be  thrilled by this, or by any suggestion that some of my abilities might decay slower than I fear. What is it about Hartshorne and Germine’s well-written paper that makes me  irritated and depressed?

Throughout our working lives my colleagues and I have lived with slurs that psychology is a non-science (or, rudely, nonsense) because the results of our “so called” experiments lead to no reliable conclusions. This has not just been a mortification  in pub bars and at dinner parties but a threat to our livelihood. During the 1980’s Sir Keith Joseph, Margaret Thatcher’s scarily clever Secretary of State for Education and Science, publicly maintained that while proper sciences like Physics, Chemistry, Medicine or Biology continually progress from incrementing bodies of reliable knowledge psychology and other “social sciences” are not “cumulative” because they endlessly rehearse the same arguments from unconvincing data. This is a costly bad rep. Unfortunately I think that Germine and Hartshorne’s breathlessness at discovering late maturing “face recognition intelligence” illustrates that bad old Sir Keith had a point.

A chronic problem while doing psychology is that we try to find quantifiable descriptions and precise explanations of our feelings, capabilities and everyday experience but, for thousands of years, this entire territory has already been thoroughly mapped in everyday language.  In common conversation the rich vagueness of words like “intelligence” allows illuminating ambiguity and  metaphors so that it is quite in order, and even helpful to speak of “chess intelligence”, “emotional intelligence” or “soccer intelligence” and we all know exactly what is going on when we do this. In psychology the word has a less generous and scintillating penumbra of meaning. Binet [2] first showed that the speed with which children can solve simple but unfamiliar problems very strongly predicts how well they will do at school, even at subjects that they have not yet attempted. Hundreds of convincing studies continue to find that, at any age, tests that measure speed of problem solving are practically useful because they identify individuals who can learn new mental skills faster and perform them better than others can. To call this ability to solve simple problems quickly “intelligence”, and so to call particular sets of simple problems “intelligence tests” has been an irresistible, tedious mistake. Wiser researchers, like Charles Spearman spoke of  “gf”, (“general fluid ability”) to signal that it is a capacity associated with better performance on very many different kinds of mental tasks and also that it is a statistical construct that has been defined by  factor analyses conducted to find common variance between  the scores that thousands of different people achieve on different sets of problems. Further work found that peoples’ scores for geometric and symbolic problems are strongly, but incompletely related to their success on problems expressed in words and that men, on average, score slightly higher than women on spatial tests. To compare scores on these different kinds of tests is reasonable because in both cases the problems are chosen to be sufficiently novel that peoples’ results are unlikely to be affected by their different, previous experiences. Other contrasts between scores on different kinds of tests cannot be interpreted in the same way.  Women often have larger and more precise vocabularies than men and both sexes can keep, or even increase their stocks of words in old age. Since all words must be learned it is not surprising that interest in  new words might differ between genders or that vocabulary takes years to peak.

John Horn and Raymond Cattell [5] were among the first to articulate this difference between the ability to solve many different kinds of novel problems and to learn new things, which they termed “fluid intelligence”, and the possession of  stocks of words, social skills and, by implication, gradually acquired knowledge of faces which they termed “crystallised intelligence”. To call our mental dictionaries and thesauruses “crystallised verbal intelligence” was irresistible, but a bamboozlement. Using the same, richly vague common-language word “intelligence”  for both the ability to process  and learn new information and for deployment of  learned stocks of familiar information has caused banal category confusions. A helpful analogy for the contrast between “fluid intelligence” and “verbal intelligence” is that while the speed and processer bandwidth of a computer will limit how rapidly it can enter and compute with new information of any kind the capacity of the memory in which it stores the particular programs and information that it needs to do a specific task is an entirely different benchmark characteristic, – both in terms of hardware and in terms of function.  I know of no pub or bar in the world in which fellow-drinkers would fail to recognise  the  distinction between our ability to do particular things that we have spent years learning how to do well, and our efficiency at learning any new thing. After all, we barflies have been talking about ourselves and each other for thousands of years. None of us would be surprised to be told that peak ability at “vocabulary skills” or “face recognition” or “people skills” (aka “emotional intelligence”) may take extra years to attain because they require decades of encounters with words, people and faces.

Why do able and methodologically sophisticated psychologists like Hartshorne and Germine gloss this trite distinction? Jim Coyne and other self-styled “activists” in the pursuit of error and obscurantism in science draw attention to the powerful market-forces that drive academic journals to prefer papers that are likely to gain media attention over those that offer undramatic, but in Sir Keith Joseph’s language “cumulative” knowledge about ourselves. Now journals ferociously compete with each other for reputation, and so sales.  The currency of reputation is “impact factors” derived from numbers of citations of published articles. Media attention to journal articles boosts citations so that preferring articles with “media appeal”  has become a potent weapon in Journal-Marketing. Any repeat of a hackneyed old result can be spun. Since the careers of scientists also depend on citations Hartshorne and Germaine may well be pleased at media attention. In their particular case an able journalist, Kayt Sukel [ 6 ]  has behaved impeccably. She not only  mentions the Horne and Cattell work but sought and quotes advice from  a formidable authority, Ulrich Maier, currently Editor of “Psychology and Aging” who said exactly the right thing:  he found  Hartshorne  and Germine’s  findings unsurprising because decades of work since the 1930’s  [ 6 ] has shown that both outstanding and  mediocre scientists, literary figures, musicians and artists, as well and bankers and business managers, reach their various peaks of performance in their professions at different ages.  Understandably Sukel simply offers Maier’s tolerant ennui and Germaine and Hartshorne’s enthusiasm without sharpening a point by contrasting them. An article that simply said “Old idea checks out again” would hardly be widely noticed.

It is not helpful to ask “Where did the spin begin?”. The pass was already sold once Binet and every psychologist adopted the word “intelligence”. Horn and Cattell made a useful distinction between the age-fragility  of innate abilities and the durability of learned skills but fumbled this by using the same, richly imprecise, word “intelligence” for both. So my old colleagues and I have stood for decades  in the shabby little  village fairground of our subject watching the same tatty old misconceptions going  around and coming  around like the wooden animals on Rilke’s carousel – the horses, the  lion, the deer and every now and again this same battered old  white elephant [7].

white elewphant

  1. Hartshorne, J. K & Germine, L.T. (2015).When does cognitive functioning peak ? The Asynchronous Rise and Fall of Diffeent Cognitive Abilities across the Lifespan.Psychological Science, March 13 2015 pp 1-11.
  2. Binet, A., & Simon, T. (1916).The development of intelligence in children: The Binet-Simon Scale (No. 11). Williams & Wilkins Company
  3. g. see review in Ch 2 in Patrick Rabbitt,  “The Aging Mind: An owner’s manual”. (2015) Routledge, London and New York.
  4. see review in Ch 17 in Patrick Rabbitt “The Aging Mind: An Owner’s manual” (2015) Routledge, London and New York.
  5. . Horn, J. L., & Cattell, R. B. (1966). Refinement and test of the theory of fluid and crystallized general intelligences.Journal of educational psychology57 (5), 253.
  6. Sukel, Kayt, https://www.psychologytoday.com/experts/kayt-sukel March 26 2015
  7. Mit einem Dach und seinem Schatten dreht
    sich eine kleine Weile der Bestand
    von bunten Pferden, alle aus dem Land,
    das lange zögert, eh es untergeht.
    Zwar manche sind an Wagen angespannt,
    doch alle haben Mut in ihren Mienen;
    ein böser roter Löwe geht mit ihnen
    und dann und wann ein weißer Elefant.
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Age, Committees and the Power-point Revolution

During fifty years of paid employment I became blasé about Committee Meetings but in retirement I forgot many things I had  learned in cheerless rooms: guessing which curly-edged sandwiches have least-worst fillings;  the ritual self-positioning of Committee-members in their, obscurely, favored seats; their preliminary interventions advertising who they are, what they know and how extraordinarily well they know it; differences between individuals’ theoretical and practical grasp of affability skills; the honed geniality of chairpersons; manic fixed beaming of some participants and poker-faces of others.
Unexpectedly I have again attended some meetings. Things have changed. Now that I am visibly old  people are disconcertingly helpful. If they find me lurking in corridors searching for the Committee-Room they do not ask where I want to go but simply tell me where the toilets are. They explain lift-buttons to me. They do not jostle me at the sandwich table but give me too many paper-plates. They smile kindly as I fumble in my rucksack for my tatty notebook, the one ballpoint of four that still works and my two pairs of spectacles – one for writing and the other for screen watching. Then, gradually, boredom seeps from the buttocks up the spine and  neck to the brain bringing subtle and particular flavours of ennuis distilled from a lifetime of forgotten meetings. But a dazzling new thing has happened while I have been away: The Power – Point Revolution !
Back in the day power-point slides, at least those used by respectable cognitive-aging persons, were simple black-on-white lists of bullet points to remind us what to say next rather than to distract  audiences from our verbatim rehearsal of exactly the same words. Power-Point virtuosi, often women, might introduce sprigs of flowers or flowing pastel smears around their text. Brasher mavens caused arrows to prance between numbers or bits of text to drop suddenly into the screen, often with loud twangs. Graphs were very simple and often wonky, encouraging audience participation with demands for return to slide 93 (where error bars had been forgotten or axes reversed so that the data precisely contradicted the speaker’s argument). Tables were grey chicken-wire-fences of tiny illegible numbers. But  Now! A New Age has dawned, all is changed utterly, and a terrible beauty is born. To de-construct these astonishing changes we use techniques borrowed from Art Historians.
Hindsight reveals a transitional period from bullet-points and bad graphs to “Mature Early Power Point”. This  reached its apogee of complexity with Structural Equation Model Diagrams. Blobs of various shapes, some designating particular classes of variables and some intriguingly arbitrary were each labelled in tiny print and joined by arrows whose directions were critical to  arguments that could alternatively be expressed in equations, numbers or even words. Arrows were often  labelled with very faint numbers indicating relative weights. Slides increased in complexity until their  full flowering in a phase that my colleague Cameron Camp termed  “Thanksgiving Turkey School”.  At this point Power-Point theory moved beyond any pretence that  slides are simplified and condensed representations of arguments. In what we may call the “Transitional Pre-Contemporary Period” divorce of blob-shape from variable class became  complete; all arrows were logically reversible in direction though, with coy playfulness, they were still given single barbed heads; complete omission of numbers signalled disdain for quantification. To emphasise the new freedom diagrams sometimes, with charming caprice, were split into two or more independent, unconnected sections.

As with all  Art Movements new ambitions required a new vocabulary. Increasing use of words such as “Eudaimonic” has became a signature of the period. The unwary  will decode “Eu” as a prefix meaning good, or pleasant, and “daimons” as subordinate characters in a Harry Potter Saga. Not so! The cunning authors have set a witty trap! A recent source explains “ Some researchers claim that eudaimonic well-being is best achieved through personal development and growth , others through finding meaning in their lives. One way or another, they agree that there must be something else out there in addition to pure pleasure and happiness.” [1]
In other words Contemporary power-point slides now try to express the numinous or indefinable. The core of the Power-Point Revolution is that slides no longer aim to illustrate or reference any argument. We transcend weary convention to gallantly eff the ineffable.
The next, Post-Transitional, phase, we  provisionally call “Early Mandala” [2]. This  taps deep roots in the  the human psyche. For example, very long ago I used to decorate my school notebooks with” Pat Rabbitt, 272 The Tideway, Rochester, Kent, England, United Kingdom, Europe, The World, The Solar System, Nearest Galaxy to Andromeda, The Universe” ( The Multiverse was not then imagined). Post-transitional slides cheekily retain the refreshingly naivety of childish scribblings. An early example of  this genre is a  “Pre-concentric” or “Cascade Mandala” slide  from NICE [3] on inequalities of population health. This  is clearly “British School”: whimsically top-down from  general to enfold  and even to cuddle particular points:

 

Health Inequalities and Population Health

A currently dominant trend shifts from British Cascade to  “Tibetan  School” with concentric circles with embedded legends. A fine recent “Model” (Mandalas are always called “Models”, except when they are diffidently called “Frameworks”) is a diagram by Bath and North East Somerset Council in a document discussing Provision of Public Toilets [4].

 

Bath Toilet Mandala

This is a breathtakingly complete depiction of a Total Universe of Public Toilet Provision! The global ecosystem with its hints of possible climate change and their effects on global biodiversity envelops concentric circles of increasing particularity until we reach the still centre of “People”, with their defining qualities of Age, Sex and genetic diversity. I am completely convinced of the importance of Age and Sex in toilet provision but less so of Heredity. Nevertheless, we must open our minds to all possibilities of future discoveries. Who knows what Genetics may yet reveal?

It is crucial to grasp that  contemporary Power-Point Mandalas are not  representations of any “things” or “arguments”. A Mandala is, rather, a noumenon, a ding an sich that needs no link to, or constraint by artificial ideas of “reality”. It simultaneously hints at  all, and no, possible interpretations. The text in which the fine Bath and Somerset Toilet Provision Mandala is embedded never refers to it as a scaffold for an argument. The  aim is to convey insights beyond verbal definition: in this case the implication of God-like overview by a benevolent Local Authority.
As always  in Art History we can track emergent themes through temporal and geographical variants. In an  instructive adaptation by the University of New South Wales Social Policy Research Centre [5] the still core of the gyre shows cryptic Words of Power: “Holistic SEWB”. Clockwise arrows in the outer circles do not signify directions of causality or flow of relationships. They are there only to convey dynamism and urgency. Charming homage to Aboriginal dot-paintings and a colour scheme borrowed from yellow and ochre pinjun desert sand are  Australian signatures and by no means accidental attributes of this remarkable “Dreamtime model”:

 

TristanSchultzArtwork Seven Domains of social and emotional well-being

An example in a brochure by Yukon Wellness California [6] shows how, the outermost circle  wittily recalls and mocks a fusty convention that “directional arrows” signify causal links. Here arrows are replaced  by  brown, khaki and blue diamond shapes, squiggles and semi-circles. So we gently but robustly expose as obsolete the fiction of connected arguments and causality.

 

holisticmodelwellness-Yukon Wellness California

During years of retirement I have wasted my time by dully continuing to analyse numbers and to write old-fashioned papers about the patterns I find in them. I hope that I am not yet too old to appreciate, and even to adapt to this huge,  enthusiasts might even say “Tectonic” shift in the nature of  representation in my field. I have begun work, as hard as my age allows, on a Universal Reaction Time Mandala with compartments for Simple and Choice RT paradigms, serpentine tracks of repetition and fore-period-duration borrowed from Kalahari Bushman Stone Etchings and, as due homage to Wilhelm Wundt, symbols in Deutsch Schrift symbolising trial – to – trial variability, signal discriminability, and choice of responding limbs. I am at last ready to come out of the closet of humdrum explications of “processes” and “mechanisms” and to dare to depict, in glorious entirety and in many cheerful colours a universe in which Reaction Times simply…… exist ! I shall offer this “Model” gratis for use in Brocuures and grant proposals by Local Governmental Authorities, Boards of School Governors, Big Pharma and miscellaneous Sociologists as a revelation and celebration of how the Science I once practised has been transformed in the few years while I have been distracted from its astonishing progress.

1. http://www.positivepsychology.org.uk/…/34-the-concept-of-eudaimonic-well-being.
2. Mandala (Sanskrit: मण्डल Maṇḍala, ‘circle’) is a spiritual and ritual symbol in Hinduism and Buddhism, representing the Universe. The basic form of most mandalas is a square with four gates containing a circle with a center point. Each gate is in the general shape of a T. Mandalas often exhibit radial balance.
3. https://www.nice.org.uk/advice/lgb4
4. Toilets | Bathnes – Bath & North East Somerset Council
5. https://www.sprc.unsw.edu.au/
6. http://www.yukonwellness.ca/holistic.php#.VWcqmM9Viko

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Hot and Cold in Old Age

spring-tulips

 

Oxford Springs are slow and deceitful – tiny progress cancelled by returns to grey dank – but this April was wonderful. The Met Office says it has been the best ever recorded. I sat and read in the sun on the kitchen roof and saw my extremely eminent neighbour, 50 feet away, cautiously de-hibernate and open his bedroom window for the first time in 5 months. We waved, reaffirming for our 15th time the traditional British Neighbour Spring  Pact: “ Better weather means that our images may more frequently fall  on each other’s retinas but, notwithstanding this, no higher-level perceptual processing shall occur and, unless you or I begin to spontaneously combust, we shall never, ever, attempt conversation.”
Though kitchen-roof-tulips are out May is not yet wonderful. The tulips seem to like rain. I don’t. The Met Office thinks it will soon be warmer, drier and fit for roof-reading again. To prepare for the change I read what I can find about how altering seasons affect oldies like me.
Most Spring Poetry is unhelpful because it bangs on  about young yearnings. Basho is better tuned to geriatric inner weather: “Spring rain leaking through the roof dripping from the wasp’s nest” reminds me to do something about Mason bees excavating the bedroom wall but does not launch my spirit into Vernal Trajectories. “Spring Air, woven moon and plum scent”? A little better, but hardly in Oxford? “Sitting quietly, doing nothing, Spring comes and the grass grows by itself” catches the mood but also reminds me that the lawnmower is rusty. Paraphrased for those who are no longer at his imaginary perpetual “one-and –twenty” Houseman was a gloomy old toad, even in Spring:

“Of my three score years and ten,
Sixty will not come again,
To take from Seventy springs this score,
Only leaves a decade more”.

(OK, OK, Alfred. Just stop going on about it).

Do epidemiology and cognitive gerontology have anything  interesting to say about the way human spirits swing with the seasons?

The German Federal Bureau of Statistics publish data that most North-Northern Hemisphere residents will recognise. Between 1946 and 1995 deaths were most frequent between January and March, fewer during Springs and least in Summers [1]. The analysts speculate that greater mortality was related to lower temperature since it reduced with spread of domestic central heating. There is a well-documented Winter increase in incidence of cardiovascular problems, including myocardial infarctions and Strokes. This is followed by a fall in Spring to a Summer low which is more marked for old than for young [2]. An analysis of Japanese Vital Statistics between 1970 and 1999 sharpened this point by including simultaneous weather conditions. Deaths from infectious and parasitic diseases, tuberculosis; respiratory disease; pneumonia and influenza; heart and cerebrovascular diseases; diabetes;  digestive diseases and accidents all peaked with low temperatures in Winter but Suicides peaked with high temperatures in Spring and Autumn [3]. Italian suicides from 1984 to 1995, (31,771 males and 11984 females) also peaked in Spring and then dropped to an Autumn low for both sexes,- but this was true only for suicides by violent means. Non-violent suicides were evenly spread throughout the year. There were similar numbers of  violent and non-violent suicides but a wider literature suggests that their causes are not the same. Violent suicides seem to be passionate events related to disturbances in relationships at higher temperatures. Non-violent suicides are more often due to other chronic miseries. This story seems plausible but, if it is true, it is odd that the proportion of violent suicides should not decline with age and that seasonal differences in  numbers of violent and non-violent suicides were greater for the old [4].

Seasonal changes affect depression and mood. A small study found that 250 Boston women aged 43 to 72 were more Tense or Anxious, Depressed or Dejected, Angry and Hostile, Tired and Inert and Confused and Bewildered in the Autumn, but much better in the Spring and Summer [5] 400 mgm supplements of Vitamin D  (which we need sunlight to produce) did not help. Differences might also have been associated with opportunities for exercise which followed similar trends. This is important because in the N. Hemisphere winters keep elderly people indoors where they are not only bored and isolated but also inert. A British study found that older people were slightly more miserable in the Autumn and Winter than in the Spring and Summer [6] and cites other studies that have found parallel, but much greater, differences for young women of child bearing age. I am sure that a bleak winter’s day imprisoned at home with one or more infants is far more frustrating than quiet isolation in a warm room with a book or a lap-top. Increases in sadness with onset of Autumn and the progress of winter are common. In extreme Northern latitudes they are sometimes so severe as to qualify for a specific psychiatric diagnosis, “Seasonal Affective Disorder” (SAD). A Swedish review of published studies suggests that, in Sweden, it is common to be glum in Autumn and Winter and that the incidence of the most severe manifestation of glumness, SAD, varies from 0% to 9% and increases the further North you live [7].

So, with the Spring Equinox now well behind us, Northern oldies swing from SAD land into glad warm Summer. We shall read in the warm sun, get out and walk about much more and take the cheering exercise that we have avoided throughout a long dull winter. If we commit suicide there are greater odds that we will go out violently with a bang or a squelch rather than  just a plaintive whimper. With global warming now evident the likelihood of heat waves and other extreme events will surely increase. Will this be a good or bad thing for our survival and morale ?

Blazing Sun

Recent studies anticipate problems for older people. The problems of harsh winter weather are obvious but a Japanese study covering summers of 1968 through 1994  found significant rises in deaths of children and elderly during temperature peaks of 38 deg C or more. I feel that I am more comfortable at high temperatures than most of my friends are, and that a reptilian ability to happily bask has strengthened in old age. I am probably wrong. A small but useful study found that both older and younger people feel most comfortable at temperatures between 20 deg C and 22 deg C but also that the old have problems because their perception of temperature changes is so coarse and sluggish that they may not notice as they gradually chill down – or heat up – outside this range [8]. Analysis of records of elderly patients admitted to a French Hospital emergency department during the 2003 French heatwave found that 42 out of 246 had heat – related illnesses not diagnosed by their physicians and that living in institutional care and taking psychotropic medications were risk factors [9]. A study of heat-stroke deaths in Japan between 1968 and 1994 found that numbers rose sharply when temperatures rose to 38 or above and half were people aged under 4 or over 70.[10] I had been looking forward to The Great Warming, especially in North Oxford, but these numbers, and increases in counts of exotic pollens now wither my hopes.

So, back again to poetry in the hope of some relief from the realisation that when we all begin to freeze or fry we old, and the very young, will suffer before the rest. Robert Frost is not particularly cheerful, but at least is poised and balanced:

Some say our world will end in fire,
Some say in ice.
From what I’ve tasted of desire
I hold with those who favour fire.
But if we have to perish twice,
I think I know enough of hate
To say that for destruction ice
Is also great
And would suffice.

1. Lerchl, A. (1998). Changes in the seasonality of mortality in Germany from 1946 to 1995: the role of temperature. International journal of biometeorology, 42(2), 84-88.
2. Sheth, T., Nair, C., Muller, J., & Yusuf, S. (1999). Increased winter mortality from acute myocardial infarction and stroke: the effect of age. Journal of the American College of Cardiology, 33(7), 1916-1919.
3. Nakaji, Shigeyuki, et al. “Seasonal changes in mortality rates from main causes of death in Japan.” European journal of epidemiology 19.10 (2004): 905-913
4. .Preti, A., & Miotto, P. (1998) Seasonality in suicides: the influence of suicide method, gender and age on suicide distribution in Italy Psychiatry Research, 81, 219-231.
5. Harris, S., & Dawson-Hughes, B. (1993). Seasonal mood changes in 250 normal women. Psychiatry research, 49(1), 77-87.
6. Eagles, J. M., McLeod, I. H., & Douglas, A. S. (1997). Seasonal changes in psychological well-being in an elderly population. The British Journal of Psychiatry, 171(1), 53-55.
7. Magnusson, A. (2000). An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatrica Scandinavica, 101(3), 176-184.
8. Collins, K. J., Dore, C., Exton-Smith, A. N., Fox, R. H., MacDonald, I. C., & Woodward, P. M. (1977). Accidental hypothermia and impaired temperature homoeostasis in the elderly. BMJ, 1(6057), 353-356.
9. Fish, P. D., Bennett, G. C., & Millard, P. H. (1985). Heatwave morbidity and mortality in old age. Age and ageing, 14(4), 243-245.
10. Nakai, S., Itoh, T., & Morimoto, T. (1999). Deaths from heat-stroke in Japan: 1968–1994. International journal of biometeorology, 43(3), 124-127.

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