Welch Wanderings Page 2

Rx for Optimal Aging

"Is bingo more important than exercise in making older people survive longer?" That was the question posed by one British reporter after Tom Glass' article about promoting good health among the elderly appeared in the summer 1999 British Medical Journal. Glass had found that social and productive activities appear to lower the risk of mortality among elderly Americans as much as fitness activities do. His findings captured the attention of the media; Glass did 65 press interviews in two weeks.

Glass, an assistant professor in the Department of Epidemiology and one of the core faculty at the Center on Aging and Health, chuckles good-naturedly at the over-simplification of his 13-year study. "I find the questions about whether older people should stop exercising very puzzling," he says. "What we're saying is not that social and productive activities are more important than exercise. It's that they, along with exercise, have an important role to play in longevity."

For too long, Glass says, researchers have assumed the key to better health for older people was physical activity; that assumption, in turn, has led to substantial investment in exercise programs for the elderly. But Glass' research shows that activities in which older people play meaningful social roles appear to offer as much advantage to survival as physical activity. His study of nearly 3,000 people age 65 and older in New Haven, Connecticut, showed that social activities (attending church, traveling, playing cards) and productive activities (like gardening, cooking, and doing volunteer work) lowered depression and disability levels, and increased longevity. And, he notes, such activities were strongly associated with survival even in those who were physically inactive. "It's so clear that a great deal of misery, illness, and dysfunction in older people is the result of atrophy - not just physical, but mental and emotional," he says. "Therefore, a prescription for successful aging should include not just physical activity, but also social and productive activity."

Given that life expectancy is increasing by the year 2050, the number of Americans age 90 and older is expected to grow from the present 1 million to 10 million an increasing number of people will be living one-third of their lives after retirement. Glass is concerned with finding ways to help people feel their post-retirement lives are meaningful. He says Experience Corps, a three-year-old program run by Hopkins' Center on Aging and Health that places older people in urban schools as tutors and mentors, offers one model worth replicating. Members of the "corps" have reported feeling stronger, more energetic, and healthier as a result of their volunteer work.

"The amount of energy it takes to work with elementary school kids is akin to a Tae-Bo workout," says Glass, who co-directs Experience Corps with Linda Fried, MD, MPH '85, a professor of Medicine with joint appointments in Epidemiology and Health Policy. "But it's not just exercise. It's doing something productive."

Glass, PhD, MS, hopes his study's results, and the success of programs like Experience Corps, will force Americans to re-envision life after retirement. "This idea that post-retirement life should be a vacation is not the right model," says Glass. "I would love to see the day when a geriatrician writes a prescription for volunteering." — LW

And We're Not Skin Doctors, Either!

"My first reaction was, 'We're in a cartoon in The New Yorker. We finally made it!'" says Jonathan Samet of the cartoon that celebrates a profession whose work has long befuddled the American public.

That epidemiology debuted Nov. 26 in a New Yorker cartoon reveals how much the fall's anthrax attacks have affected pop consciousness.

Acute outbreaks capture the public's attention in a way that long-term research doesn't, notes Samet, MD, MS, chair of Epidemiology and the Jacob and Irene Fabrikant Professor in Health, Risk, and Society. "It takes us a while to say lung cancer rates are going up. I say 'a while'; it takes decades," says Samet.

As the pop spotlight shifts elsewhere, epidemiologists will no doubt once again become accustomed to their discipline being ignored or misunderstood by the public. "We are usually confused with dermatology," Samet laments. - BWS

Epidemiology's New Breed

In her recent survey of low-income women in Baltimore who suffered physical and sexual abuse, Patricia O'Campo, PhD '89, and her colleagues were dismayed to find that although 22 percent of women had wanted help from professional service agencies, only 14 percent actually received any support from them.

Published in the February issue of Patient Education and Counseling, the study of 340 women living in Baltimore underscores not only the dearth of services for women in abusive relationships but also the importance of education and job training that will enable these women to become economically independent.

O'Campo, an associate professor of Population and Family Health Sciences, has coupled a longstanding passion for the challenges faced by low-income women with an interest in new epidemiological methodology. She counts herself one of a new breed of social epidemiologists who in the 1990s began to look beyond individual demographic data to see if the characteristics of a neighborhood contributed significantly to the health outcomes of its residents.

Old-school epidemiologists were initially skeptical. Take, for example, her 1995 study that examined the factors involved in women bearing low-birthweight babies. Conventional wisdom held that individual characteristics of the mother such as education, in-come level, and her willingness to seek prenatal care were most important in determining whether she would have a low-birthweight baby. O'Campo's study showed, however, that the risk depends as much on where a mother lives as it does on her eating habits and use of prenatal care. That is, getting early prenatal care and eating all the right foods do not necessarily reduce a mother's risk, if she also happens to live in a census tract where crime and unemployment are high, homeowners are few, and per capita income is low. (O'Campo won't hazard a guess as to why this is the case, but she hopes her future studies will determine the reason.)

Because the 1995 study considered data on neighborhoods as well as on mothers, it generated some initial resistance. "In fact, the manuscript got stuck in the journal's review process for two years before it was finally accepted," remembers O'Campo.

O'Campo, whose current prospective study will extend over the next four years, is quick to acknowledge that an individual's behavior can affect his or her health. "But if we base our policy recommendations and intervention strategies entirely on individual-level data," she says, "we may be overemphasizing changing individual behaviors while ignoring the even greater results to be gained by improving neighborhood conditions." — RG

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