After all, what’s the point? Once you’ve passed your genes on to the next generation, why stick around? Why take up space and use food and other scarce resources? It’s the young who need those things to live to reproductive age. So why do old animals even exist? Or old people?

Evolution has no reason to favor long life, Steven Austad, a former lion tamer and now a bio-gerontologist at the University of Alabama at Birmingham, points out. Quite the contrary, he says: “Evolution favors early, copious reproduction at the expense of later life survival.”[i]

S. Jay Olshansky, a biodemographer at the University of Illinois, Chicago, puts it this way: “We age because Mother Nature turns her back on us once we’re in the post-reproductive region of the lifespan. Natural selection didn’t build in a program to make us fall apart later in life.”[ii]

And yet here we are, a world with growing numbers of old people, even very, very old people. Was it “supposed” to be this way? Come to think of it, why is there even such a thing as menopause? Why do women live 30, 40, 50 years past reproduction? (There’s less of a question about old men – some can produce viable sperm until the day they die, though getting it to its proper destination can get iffy).

Perhaps, as one school of thought suggests, aging exists because old animals – especially females – provide evolutionary advantages, not to the old animal herself, but to her offspring and genetic relatives. It’s the so-called “grandmother effect.”[iii]

“If you are a human female and you are taking care of your grandchild… your act of taking care of your grandchild is a reproductive act,” at least in the eyes of evolutionary biologists, says Michael Rose, a professor of ecology and evolutionary biology at the University of California, Irvine.[iv]

Actually, grandfathers are sometimes just as important as grandmothers because they, too, share food, and sharing is evolutionarily crucial, says Harvard University evolutionary biologist Daniel Lieberman.[v]

A hunter-gatherer mother requires enough calories to sustain not just her own body but the bodies of her children as well, Lieberman notes, which means that hunter-gatherer females who are lactating and caring for young children struggle to get enough energy.

“But grandmothers and grandfathers are unencumbered – they can produce a surplus,” he says. “And that energy goes toward the family. As soon as humans started sharing, there was a strong selective pressure for longevity.” (Longevity, as we’ll soon see, is also fostered by “nice” environments, with lots of food around.[vi])

Among other things, older animals are handy because they know where to find long-forgotten watering holes or food supplies. Female post-menopausal killer whales (orcas) are terrific resources for their tribe – they know where scarce salmon are and are often the ones who lead others to food when supplies are low.[vii]

Old female elephants are great resources, too.[viii] In fact, elephant societies are famously matriarchal, with older females helping their herds survive droughts, food scarcity, poachers and, of course, lions.[ix] [x]

Some traditional human societies with long-lived men and women show a similar pattern, says Jared Diamond, a professor of geography at the University of California, Los Angeles who for more than 50 years has studied New Guinea farming societies.

To be sure, he says, nomadic, hunter-gatherer societies aren’t always kind to old people, who may be cast out to die or simply left behind if they can’t keep up with the group’s wandering.

But in sedentary traditional societies, old folks are valuable. “In traditional societies without writing, older people are the repositories of information,” Diamond says. “It’s their knowledge that spells the difference between survival and death for their whole society in a time of crisis caused by rare events for which only the oldest people alive have had experience.”[xi]

That’s exactly what happened in 1993, when an outbreak of the hanta virus triggered a spate of deaths on the Navajo reservation in the Four Corners area of the American Southwest. The virus, originally, and unfairly, dubbed the “Navajo flu” and since renamed the Sin Nombre (No Name) virus, is carried by deer mice. When the feces of deer mice dry up and become aerosolized, humans can unknowingly breathe the contaminated dust and come down with often-fatal pulmonary infections.

When the outbreak hit, scientists from New Mexico’s health department and the federal Centers for Disease Control and Prevention flocked to the Navajo reservation to study the virus.  But it was their wise decision to talk with Navajo elders that cracked the case.[xii] [xiii] [xiv]

The Navaho elders remembered that twice before in the 20^th century, they had observed a connection between increases in rainfall, a booster crop of pinyon nuts, and a surge in the deer mouse population. In 1993, those exact conditions pertained – unusually heavy rains, lots of snowmelt, huge quantities of pinon nuts, a surge in deer mice, and a not-new-after-all epidemic deciphered by the oldest folks around.

Clearly, then, there are some benefits for the group as a whole to have to older animals or people around.

But this can’t be the whole story. After all, evolution didn’t “plan” for older people to hang around because evolution doesn’t “plan” anything. There must be some other reasons, including genetics, why some creatures live long past reproductive age.

Indeed there are. I explore many of these in my new book, Exercise is Medicine. I hope you’ll be as fascinated as I was.

---

[i] Austad, S. (personal communication, Feb. 23, 2016).

[ii] Olshansky, S.J. (personal communication, Aug. 15, 2016).

[iii] Abrams, L. (2012, Oct. 24). The Evolutionary Importance of Grandmothers. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2012/10/the-evolutionary-importance-of-grandmothers/264039/

[iv] Rose, M. (personal communication, Aug. 15, 2016).

[v] Lieberman, D. (personal communication, Aug. 12, 2016).

[vi] Kaeberlein, M. (personal communication, Oct. 8, 2016).

[vii] Yong, E. (2015, Mar. 5). Why Killer Whales Go Through Menopause But Elephants Don’t. Phenomena, National Geographic. Retrieved from http://phenomena.nationalgeographic.com/2015/03/05/why-killer-whales-go-through-menopause-but-elephants-dont/

[viii] Yong, E. (2015, Mar. 5). Why Killer Whales Go Through Menopause But Elephants Don’t. Phenomena, National Geographic. Retrieved from http://phenomena.nationalgeographic.com/2015/03/05/why-killer-whales-go-through-menopause-but-elephants-dont/

[ix] Fishlock, V. (2011, Jun. 9). Why Matriarchs Matter in Elephant Society. International Fund for Animal Welfare. Retrieved from http://www.ifaw.org/united-states/node/2842

[x] Ogden, L.E. (2015, Jan. 26). The Power of Elephant Matriarchs. National Wildlife Federation. Retrieved from https://www.nwf.org/News-and-Magazines/National-Wildlife/Animals/Archives/2015/Elephant-Family-Behavior.aspx

[xi] Diamond, J. (2013, Nov.). How Societies Can Grow Old Better [Lecture transcript]. TED. Retrieved from https://www.ted.com/talks/jared_diamond_how_societies_can_grow_old_better/transcript?language=en

[xii] Wrobel, S. (1995). Serendipity, science, and a new hantavirus. FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology, 9(13). 1247–1254.

[xiii] Foreman, J. (1993, Jun. 14), Stalking a Mystery Illness. The Boston Globe. Retrieved from https://www.highbeam.com/doc/1P2-8232177.html

[xiv] Foreman, J. (1993, Jun. 7). CDC Seeks Further Tests at Reservation for clues to disease. The Boston Globe. Retrieved from https://www.highbeam.com/doc/1P2-8231069.html

Good news, folks! Some things actually get better with age, and I’m happy to say that emotional stability is one of them. It says so right in the authoritative Journal of Neuroscience.

Ever since Freud, psychologists have focused almost exclusively on misery — our fears, our depressions, sadness, anger, hostility, aggression, you name it. Now, thank goodness, the young discipline of “positive psychology” is gaining ground as psychologists and neuroscientists try to figure out what makes people happy.

One of the most provocative studies in this new field was published last summer in the neuroscience journal. Australian researchers studied 242 healthy people aged 12 to 79. The subjects were shown pictures of fearful faces and happy faces, while their brain responses were tracked with functional MRI scans and EEG, or electroencephalograms, which show the regions of the brain active at any given moment. The findings suggest that people get less neurotic, more able to control fear, and more emotionally stable as they age, an observation that fits with other data.

Specifically, the Australian team found that the amygdala — a deep brain center for processing raw feelings, especially fear — becomes less reactive to fearful stimuli between older and middle years, while a higher brain center, the medial prefrontal cortex, which governs planning and judgement, gets more active between the middle and later years.

This suggests that healthy, older people “are less bothered by things. They are more in control of their reactions to fear,” said Dr. Andrew Leuchter, director of the Laboratory of Brain, Behavior and Pharmacology at the David Geffen School of Medicine at UCLA.

The findings also suggest that aging is not only linked to “putting the brakes on” negative emotions, but to “releasing the brakes” on positive emotions, said Lea Williams [cq], a neuroscientist at the University of Sydney in Australia and lead author of the study. These findings, she said in an e-mail, “are consistent with people reporting that they focus more on quality of life as they get older. Our many experiences do impact our emotional brain systems in a way that helps attain a better sense of comfort with oneself and the world.”

The neuroscience data fits with some epidemiological data. A 2004 study from the US Centers for Disease Control and Prevention showed that young people report more sad, blue or depressed days per month than older people – 3.4 per month for 20 to 24 year olds, versus just over 2 days for people 65 to 74.

Another government study, the 2003 National Health Interview Survey, asked people how often they felt sad, hopeless, worthless or that everything was an effort. The least sad were people aged 65 to 74. Only 2.6 percent of this group said they felt sad all or most of the time, in contrast to 3 percent of the 18 to 44 year olds. After age 75, however, it’s not clear whether the happy trend continues — and a lot more research is needed.

The idea that many people do indeed mellow with age makes sense to Dr. George Vaillant, a senior psychiatrist at Brigham and Women’s Hospital and director of the Harvard Study of Adult Development who for decades has studied the way people change over the years.

Older people “modulate emotion better than the young, which lets them be more ‘Buddhist’ and thus happier because their frontal lobes are better connected to their limbic system,” the deeper region of the brain where emotions are processed, wrote Vaillant, the author of “Aging Well,” in an e-mail.

The general trend toward greater happiness with age makes sense to Harvard’s chief happiness guru Tal Ben-Shahar, too. Ben-Shahar, who taught one of Harvard College’s most popular courses, “Positive Psychology, said in an e-mail interview that “one of the reasons why we are happier with age is that we simplify our lives. We focus on what’s really important to us, while discarding things that are less personally meaningful.”

“When we experience negative emotions, we are more accepting and also are secure in the knowledge that ‘this, too, shall pass,'” he said.

Evolution may also play a role in helping people get less fearful and more sanguine with age, said biological anthropologist Helen Fisher of Rutgers University.

“A young person has everything to look forward to and everything to gain or lose,” she said.  It make sense for younger people to watch out for negative things that might kill them, while older people who have already succeeded in passing on their genes have less to fear, she said. “It’s now adaptive for them to be less vigilant about all the exigencies of life, to stay calm and keep others calm.”

Even though the odds are good that you will get happier as you age, there’s no need to wait. Younger people, like those in Ben-Sharar’s Harvard classes, can learn the basic skills. The first, he said, is to give yourself permission to feel negative emotions like sadness, fear or anxiety. The sooner you do, the faster these feelings will pass.

It’s also key, he said, to engage regularly in activities that you find pleasurable and meaningful. Remember, too, that happiness is mostly “dependent on our state of mind, not on our status or the status of our bank account. Barring extreme circumstances, our level of well-being is determined by what we choose to focus on and by our interpretation of external events.”

To which I say: Amen!

Grandma Moses first picked up a paintbrush at 78, reportedly after arthritis forced her to give up the embroidery for which she was already well-known. She went on to paint for more than 20 years, finishing her last big canvas at 101.

Giuseppe Verdi, the Italian composer, was also no slouch in old age. He produced his greatest masterpiece, “Otello,” at age 74, and his final opera, “Falstaff,” at 80.

Albert Einstein didn’t rest on his youthful laurels, either. After winning the Nobel Prize in physics at age 42, he became a political activist, crusading against atomic weapons until his death at 76.

And Nelson Mandela? The anti-apartheid leader didn’t even become president of South Africa until he was 76.

Despite such dazzling late-in-life success stories, neuroscientists for decades were pessimistic about the aging brain. Sure, a few standout individuals blossomed in their 70s and beyond, but they could point out that for every Einstein, there was an Isaac Newton, an equally great scientist who spent his later years preoccupied with alchemy and other pseudoscience.

The neuroscientists’ gloom was based on their belief that aging causes a steady loss of neurons (brain cells) all over the brain. They “knew” the adult brain could not generate new neurons. Worst of all, scientists assumed that nothing could be done to boost the odds of having a healthy, aging brain.

“It was thought that these changes began among individuals in young adulthood and progressed inexorably across the adult lifespan,” said Marilyn Albert, director of the Gerontology Research Unit at Massachusetts General Hospital.

Much of that, scientists have learned over the past decade, was too pessimistic. The aging brain, it turns out, is surprisingly “plastic” – capable of remodeling itself, growing new cells, and compensating in remarkable ways for the very real losses in processing speed that come with aging. And the brain is quite good at using the knowledge accumulated over decades to function well in everyday life.

Today, thanks to better techniques for studying post-mortem brain tissue, more sophisticated brain scans of living people and perhaps most important, a shift in emphasis from studying sick older people to studying healthy ones, neuroscientists have a much rosier view.

“The changes that occur with aging are much less widespread in the brain than we used to think,” Albert said. “And we now know there is a lot that people can do to maximize brain function in later life.” Many studies have contributed to this increasingly optimistic view of brain aging, but a few have proved pivotal.

In 1998, a team led by Fred H. Gage, a neuroscientist at the Salk Institute in La Jolla, Calif., showed that, contrary to popular belief, the adult human brain contains cells that can divide and become healthy, new neurons.

Though this had been previously shown in rats, cats and some monkeys, the Gage study electrified researchers in part because dividing brain cells were found even in the hippocampus, a region crucial for learning and memory. Equally impressive, dividing cells were found in people as old as72.

“The good news is that the adult brain retains the capacity for cell genesis and neurogenesis,” Gage said. “And this capacity persists throughout life. It is amazing.”

Just as important, Gage noted, researchers are discovering that physical exercise and intellectual enrichment can help stimulate this capacity.

Marian Diamond, a neuroanatomist at the University of California at Berkeley, has pioneered the study of brain improvement with more than 30 years of testing the mental capacities of rats in different types of cages normal cages with little inside and enriched cages containing lots of toys.

After leaving the animals in the cages for specified periods of time, Diamond sacrifices them and examines their brains to count the number of dendrites – filaments that extend outward from brain cells to pick up information. Whether the rats were young or old (the equivalent of 90 in human years), an enriched  environment seems to stimulate proliferation of dendrites, she found.

“This is why we’ve gone to the optimistic view of aging,” Diamond said.

Gage’s team, too, has shown the power of an enriched environment to keep aging brains healthy. In fact, his team has shown that an enriched environment leads not just to new dendrites but to a 15 percent increase in new brain cells in the hippocampus of rats, even those that, until the experiment, had spent their whole lives in normal, that is, boring, cages.

Even more important, Gage said, what really matters in an enriched environment is exercise. Rats given the chance to run to their hearts’ content on running wheels doubled the rate at which new brain cells evolved into mature neurons, he said.

Other animal studies published in 1998 and 1999 suggest one reason for this. Exercise seems to trigger an increase in secretion of a natural chemical called brain-derived neurotrophic factor, or BDNF, which stimulates brain cell growth. But only vigorous, aerobic exercise – not stretching or toning – produces this effect.

In humans, physical exercise is also now known to be one of four key ways to protect cognitive function, according to a coalition of researchers sponsored by the MacArthur Foundation Research Network on Successful Aging. The other three protective factors are education (the more, the better), good lung function to maintain good oxygenation of the brain, and having a sense of control over one’s life.

Granted, it’s a bit of a leap from having a sense of control over one’s life to proving that stress is bad for aging brains, but psychologist Elizabeth Gould at Princeton University has shown that, at least in rats, this is true. Stress hormones block production of new brain cells in the hippocampus, she said, and other studies show that levels of stress hormones increase in aging humans. That suggests that stress may adversely affect the aging human brain and, possibly, that stress reduction techniques might offset it.

Amid the encouraging news, it is still true, as earlier studies suggested, that there is some shrinkage of brain tissue with aging, primarily in the frontal cortex, which is responsible for executive functions such as planning and organizing.

There is also some brain cell loss in clumps of nerve cells deep in the brain, such as the nucleus basalis and the substantia nigra. The loss of these cells is believed to decrease the brain’s ability to produce certain chemical messengers, such as acetylcholine, dopamine and serotonin.

And it’s well-documented that older people process information more slowly and have more trouble switching between tasks, said Jordan Grafman, chief of the neuroscience section of the National Institute of Neurological Disorders and Stroke. But it’s also well-documented that older people have bigger vocabularies and larger stores of acquired knowledge.

Moreover, even when older people do suffer losses in specific skills such as certain types of memory, their brains can compensate, said Denise C. Park, a psychologist at the University of Michigan. Brains scans such as PET and functional MRIs show that for intellectual tasks that a younger person would perform using only one hemisphere of the brain, an older person often recruits the other hemisphere or other areas in the same hemisphere to help out.

“You don’t need tremendous processing speed and working memory in everyday life, so long as you are in familiar surroundings,” Park said. “In real life, what counts is stored knowledge, wisdom and well-learned skills.”

So, Park suggested, the next time you wonder whether an older person is still competent, Park suggests, ponder this: A 1999 study that she did showed that it’s not older folks who forget to take their pills – it’s harried, middle-aged professionals.

SIDEBAR: Some Mental Skills Decline With Age… But Wisdom And Common Sense May Increase.

  KEEPING THE BRAIN IN MIND

A growing body of research suggests there are a number of things you can do to improve brain function in later life.

• Physical exercise: It helps build new brain cells, as well as strong muscles.
• Mental exercise: Duke University neurobiologist Larry Katz, author of”Keep Your Brain Alive,” suggests doing “neurobics” to keep your brain humming with novelty, including simple tricks like brushing your teeth with your non-dominant hand, taking a different route to work and finding your car keys by touch instead of sight
• Stress reduction: Nobody has proved in humans that lower levels of stress hormones help maintain healthy brain function, but they have shown that stress harms the brains of rats.
• Stay connected: Harvard psychiatrist George Vaillant, author of the forthcoming book called “Aging Well,” said that maintaining rich emotional ties is crucial to healthy aging of mind and body.
• Be creative: Your older years may be your best ones, said Dr. Gene Cohen, author of “The Creative Age.” Many people, he said, enter a liberation phase in their 60s and 70s and use a newly found sense of inner freedom to paint, write or create new social programs.
• Finally, ask your doctor if you should take ibuprofen or similar drugs. A growing body of evidence suggests these medications help prevent cognitive decline and Alzheimer’s disease, probably by blocking inflammation that can destroy brain cells.

For years, many prospective parents – and doctors as well – have blithely assumed that, if an older couple’s baby has birth defects, it’s most likely because of the woman’s advancing age.

And there’s some truth to this. The risk of mental retardation due to Down syndrome, for instance, clearly rises with advancing maternal age – from one in 1,000 at age 29 to one in 100 births at age 40. Other diseases in which a child inherits an extra copy of a particular chromosome are also linked to older mothers.

But, increasingly, scientists are discovering that, by focusing almost exclusively on mothers-to-be, they might have been barking up the wrong genome. A man, or more accurately his sperm, also has a biological clock. And it’s ticking can be just as spooky as a woman’s, perhaps even more so because its virtually impossible to do prenatal tests to pick up all the possible genetic mutations in sperm.

“There’s always been this myth that fathers can be fathers until they die, and that would be fine. It’s always the mother who had to be young,” said Dr. Eric Vilain, a geneticist and pediatrician at the University of California at Los Angeles.  But that’s because the risks associated with advancing paternal age have been routinely “underestimated.”

In fact, the risk of new mutations – those that haven’t shown up in a family before – is four to five times greater for fathers age 45 and older than for those ages 20 to 25, according to the American College of Medical Genetics. And the risk goes up linearly with time.

For the population as a whole, the average age of a father at the time of conception is still a relatively youthful 27. But it’s tough to know precisely how many men over 40 are fathering children because birth certificates often list only the age of the mother, noted T. J. Mathews, a demographer at the National Center for Health Statistics. You can’t infer the age of the father from that of the mother since many men marry younger women, either the first time around or when they start a new family after divorce.

The latest and most dramatic evidence of the risks of late fatherhood was revealed in April when Columbia University researchers published results from a large study in Israel.

Led by Dr. Dolores Malaspina, a Columbia psychiatrist, the team correlated the birth records of nearly 88,000 people born in Jerusalem between 1964 and 1976 with records from the Israel Psychiatric Registry. They found that men between the ages of 45 and 49 were twice as likely as those under 25 to have children with schizophrenia, and the children of men who were 50 or older had three times the risk. Overall, they found that advancing paternal age accounted for as many as one in every four cases of schizophrenia.

The huge sample allowed researchers to distinguish between the effects of maternal and paternal age, said Dr. Susan Harlap, a co-author and an obstetrician-gynecologist at New York University. In some other studies, she said, researchers couldn’t do that and, hence, gave too much weight to maternal age as a risk factor for particular problems.

Over the years, geneticists have linked a number of other diseases to advancing paternal age, including achondroplasia, or dwarfism; Marfan’s syndrome, which can lead to the fatal rupture of a major blood vessel; and Apert’s syndrome, or the malformation of the skull, hands and feet.

Retinoblastoma, an eye cancer; neurofibromatosis, or fleshy growths of abnormal nerve tissue; and some types of prostate cancer also have been linked with older fathers. And some diseases caused by genes on the X-chromosome, among them hemophilia, Duchenne muscular dystrophy and Hunter syndrome, have been linked to advanced age not of a child’s father but of his maternal grandfather. In these cases, an older man passes on a defective gene on the X chromosome to his daughter, who, like Queen Victoria, becomes an unaffected carrier who can pass the disease to her sons.

When certain diseases caused by genetic defects show up in a family for the first time, the odds are seven to 10 times greater that the mutation has occurred in the DNA of the father rather than that of the mother, said Dr. Victor McKusick, professor of medical genetics at Johns Hopkins University.

And there’s a good reason for this: Sperm cells are constantly dividing to create more sperm, which provides ample opportunity for tiny mistakes – mutations – to occur as the DNA is copied. By age 15, sperm cells have undergone roughly 35 cell divisions. By age 20, it’s 150; by 40, it’s 610; and by 50, 840 – hundreds of opportunities, in other words, for tiny glitches in DNA copying that result in point mutations, or defects in a single gene.

By contrast, when a baby girl is born, her tiny ovaries are full of eggs that are almost mature. The eggs just sit there  – not dividing – in a kind of suspended animation for decades. Once a woman hits puberty and starts ovulating, a single egg completes a cell division each month, the final stage of egg maturation. The egg is then released into the Fallopian tubes, where it may be fertilized by incoming sperm.

Because a woman’s eggs are so quiescent for so long, “there’s very little chance for things to get messed up,” said James Crow, emeritus professor of genetics at the University of Wisconsin.

When genetic accidents do occur in a woman, though, they are big ones – typically an extra copy of a whole chromosome. Researchers do not know why the odds of “trisomy,” or an extra chromosome,  increase as a woman ages. But when the fetus gets an extra copy of chromosome 21, the result is Down syndrome. With an extra copy of 13 or 18, the result is severe mental retardation and birth defects; with an extra copy of the  X chromosome, the result is Klinefelter’s syndrome, in which males are usually infertile.

And there are undoubtedly more instances of trisomy than most people realize because lethal abnormalities often trigger spontaneous miscarriages. “If you do chromosome studies of the products of miscarriage, a high percentage have chromosome damage,” said Dr. Wayne Grody, director of the DNA diagnostics laboratory at UCLA.

But even the single gene defects more common in sperm can have large consequences. In Marfan’s syndrome, for instance, connective tissues in the eyes, bones and blood vessels may be affected. Some people with Marfan’s go undiagnosed until, like Olympic volleyball star Flo Hyman, they die suddenly when a major blood vessel called the aorta ruptures.

And knowing which gene is at fault can be a mixed blessing. In 1994, for instance, when the gene for achondroplasia, a type of dwarfism, was discovered, some hailed it a breakthrough because it meant genetic testing was now possible. But others feared it could lead to further stigmatizing of dwarfism as a defect rather than a variation from the average.

Still, many couples would like to be able to test a fetus to see if it carried any of the potential genetic defects associated with rising paternal age, “but there’s no good way to test,” said Michelle Fox, a genetic counselor at UCLA.

In women, amniocentesis and chorionic villus sampling – both of which are somewhat invasive – can detect whole-chromosome abnormalities, such as Down syndrome. And many women who get pregnant in their late 30s or later do have their fetuses tested.

But it’s much more difficult to test for genetic problems linked to aging sperm because there aren’t enough probes to test all the possible single-gene defects. If an older man has already had one child with a syndrome linked to advanced paternal age, however, doctors can sometimes test a subsequent fetus for that same defect if the gene is known.

With so much uncertainty, the best advice for couples in which an older man wants to be a father is to ask a genetics counselor about a series of ultrasounds of the fetus. This approach is controversial because not all defects show up on ultrasound, and some that do may become visible only late in pregnancy.

And for women seeking to get pregnant through sperm donation? The best advice is to ask for a donor age 40 or under. For a more complete list of diseases linked to advancing paternal age, visit the web: www.ncbi.nlm.nih.gov/omim.

At 68, Helen Freeman of Seattle has more chronic diseases than many of us will face in a lifetime. First, there’s her labored breathing because of extensive scarring from years of lung infections.

Then there’s the diabetes, for which she needs daily medication. The glaucoma is no picnic, either – she’s almost blind in one eye. She’s also had melanoma and breast cancer.

Yet, in 1981, Freeman founded an organization to save the endangered snow leopards of Asia, a job that entailed frequent trips to Asia, where she gasped her way through pollution-clogged cities. She climbed mountains to study the leopards and nearly died twice.

Mountain climbing with a serious lung problem was, “to put it mildly, very difficult,” she said cheerfully. “I basically picked an animal that lives at 12,000 feet and I have trouble breathing at sea level.” But she was determined not to let her illnesses slow her down any more than necessary. 

More and more Americans are finding that, like Helen Freeman, they must learn to cope with chronic illness. Half of all Americans today (20 million more than researchers had previously estimated) have at least one chronic illness and one in five has two or more, according to a recent analysis by researchers from the Johns Hopkins School of Public Health.

Granted, for some of the 125 million people with chronic illnesses, the problems are minor, like allergies that can be stabilized with medications. But 60 million others have multiple chronic conditions such as heart disease, Alzheimer’s disease, cancer, arthritis, epilepsy, mental illness and others that can be serious or life-threatening.

The toll of so much illness is enormous – $510 billion annually, said Jay Hedlund, deputy director of the Partnership for Solutions, a Johns Hopkins project aimed at improving the lives of people with chronic diseases. Indeed, chronic illnesses account for 77 percent of direct medical expenditures in America, he said.  It leads to 70 percent of all deaths, according to the federal Centers for Disease Control and Prevention, and it accounts for one third of the years of potential life lost before age 65.

But chronic illness exacts an emotional toll as well, and it is in that realm that researchers are increasingly looking to the hard-won wisdom of patients such as Helen Freeman to find ways to help others cope with diseases that might once have engulfed them in shame or despair.

Take Dr. Steven J. Kingsbury, a man who is both patient and doctor. Kingsbury, 52, is an associate professor of clinical psychiatry at the Keck School of Medicine at the University of Southern California. At 34, he was diagnosed with multiple sclerosis, a potentially crippling, neurological disease that now forces him to remain in a wheelchair much of the time.

In a recent article in the Harvard Mental Health Letter, Kingsbury stated why he believes that people with chronic illnesses should be neither pitied nor idealized, either by others or themselves.

Pity can come across as condescending, Kingsbury said.  Turning someone into a hero may not help, either: “I didn’t get MS to prevent someone else from getting it, so it was not courageous. And when I go into a nice restaurant with my wife, that’s not courageous, either. It’s because I like good restaurants.”

To keep his disease in check, Kingsbury must take powerful drugs often used in cancer chemotherapy, drugs that cause nausea and diarrhea. Yet, when these side effects struck after one recent treatment, he spent the weekend reviewing articles for publication, writing a chapter on a yearbook for mental health and going over some statistics. And he got to work”bright and early Monday morning, though I did have to spend time in the bathroom.”

The point, Kingsbury said, is that people with chronic illnesses, like anybody else, feel better if they focus on other things. “If I sit around contemplating my navel, why shouldn’t I feel crappy? But if I do other things, I feel better. Anybody will suffer less if they have something better to do.”

Other mental health specialists, such as Ann Webster, a health psychologist at the Mind/Body Medical Clinic at Beth Israel Deaconess Medical Center in Boston, take a somewhat different view. Some people with chronic illnesses do want to be seen as normal, she said, but others do seem truly heroic and may appreciate some recognition of that. Some people, she said, make monumental changes when serious disease strikes.

For many people with chronic illnesses, the diagnosis is a wake-up call to change the things that aren’t working in their life, said Webster, who runs support groups for people with cancer, AIDS and other illnesses. Some people quit jobs they’ve always hated, she said. Others leave bad relationships. Others travel while they can.

“A lot of people grow and change” in profound ways,  Webster said. Some long-term survivors in her AIDS group “have changed and grown and turned into some of the most evolved and spiritual people, and they never were that way before.”

That kind of growth in the face of adversity, whether one considers it heroic or not, is never easy, cautioned Dr. Jimmie Holland, chairman of psychiatry and behavioral science at Memorial Sloan-Kettering Cancer Center in New York.

“It’s really hard having a chronic illness, and knowing it is changing your life and your future,” she said. Initially, the big problem may be learning to live with the uncertainty about how disabled you may become and whether your life expectancy will be shortened.

It’s a real struggle, she said, for people to figure out “how to cope, how to do everything they normally do,” and yet, if the prognosis is grim, keep in the back of their minds that, no matter how well they cope, they may not be able to change the course of their disease.

Some people can throw their energies into beating their disease and returning to normal activities. But others can’t beat the disease, no matter how hard they try. For them, Holland said, the challenge is “how can you put new meaning into your life when your life got shattered?” Many people can do this on their own, she said, but many also find it helpful to join support groups or see individual counselors.

Ultimately, Holland said, the task is to make meaning in the face of disability or imminent death, to reassess what’s still important and what you can still do, when your old goals and dreams can no longer be met.

Like Kingsbury, Holland saidshe believes one key to this meaning is not to let the illness define you. Other people can help buttress this outlook by not treating you as if illness were the essence of your being and by continuing to talk to you about the things you’ve always been interested in.

Helen Freeman would be the first to acknowledge that this can be tough. “It’s not easy to stop thinking you feel rotten when you actually feel rotten,” she said.  “After all, your whole body is yelling at you to pay attention.”

But what works for her, she said, is to find moments of pleasure – even if they last only a few seconds – and to complain a bit when necessary and then to go on living. Perhaps most important, she said, is to be realistic: “Don’t make perfect health the measure of who you are because perfect health is an impossible goal.”

SIDEBAR: Groups That Offer Help

There are numerous organizations to help people cope with chronic diseases.   Among them are:

• The National Chronic Care Consortium, at 952-858-8999 begin_of_the_skype_highlighting              952-858-8999      end_of_the_skype_highlighting.
• The Mayo Clinic Health Oasis, at www.mayohealth.org.
• The National Organization for Rare Disorders Inc., at www.rarediseases.org.  

For the last five years, Joyce Antler, a Brandeis University historian in her early 50s, has been living what she calls “a terrible nightmare.”

Antler lives in Brookline and is trying to manage the care of her increasingly demented, 84-year-old mother — long distance. At first, the solution seemed to be to have her mother move up from Florida to live with Antler and her family, but within a month, she says, her mother “found it impossible because we were so busy. She felt like a fifth wheel.”

So Antler’s sister gave up her apartment in New York to move back to Florida with their mother. But this has proved only marginally better, Antler says, because her sister has serious medical problems of her own.

The result is ever more frequent — not to mention expensive — plane trips to Florida, endless telephone calls to help her sister manage crises and “semi-crises” and a lot of guilt.

Antler’s dilemma is the tip of a huge iceberg that, some worry, could come close to sinking the Great Ship Baby Boomer.

In fact, if you’re among America’s 76 million boomers — born between 1946 and 1964 — and you thought finding child care was a colossal hassle, you are about to get smacked between the eyes with an even bigger problem, if you haven’t been already.

Call it the geographic crunch. Suitcase caregiving. Long-distance care management. By whatever name, managing the care of a frail or disabled parent, especially from far away, is, as Antler says, a true nightmare, and one that will almost certainly get worse as boomers and their parents age.

Many older people, of course, are willing to make a final move to assisted living or a nursing home when it looks as though they will no longer be able to manage things at home.

But most want to live out their lives in their own homes, with the right kind of help — nursing services, home health aides and someone to help with errands, housekeeping and yard work.

The trouble with that, however, is that while services are available, especially for those who can pay for them, finding them usually means cutting through miles of red tape.

That is tough enough to do if your parents live next door, and it can be “truly overwhelming” if they don’t, says Scott Bass, dean of the graduate school at the University of Maryland/Baltimore County.

Although most people over 65 live within an hour’s drive of at least one child, an estimated 7 to 9 million aging parents do not, says gerontologist Merril Silverstein of the University of Southern California.

And that gap could get worse.

Currently, 2 million working Americans — most of them women — help older relatives with activities of daily life. But the “greater geographic dispersion of families, smaller family sizes and the large percentage of women who work outside the home are straining the capacity of this care source,” the government’s General Accounting Office noted in 1994.

While hands-on care — bathing, shopping, giving medications — is the most demanding help that children can provide to aging parents, the managerial stuff — the hours on the phone arranging or monitoring help given by others — is no small task.

In fact, lining up care for aging parents is “much more complicated than setting up child care for kids,” says Dorothy Howe, acting manager of health advocacy services for the American Association of Retired Persons in Washington.

For one thing, “you’re not dealing with a dependent,” says gerontologist Bass. “You don’t have the authority, necessarily, to intervene.” Added to that is an often complex family history, sibling disputes over who should help how — and distance.

It adds up to “a very, very stressful, difficult issue,” says Bass, who adds that even “experts in gerontology are absolutely drained by the experience of traveling back and forth” to help manage parents’ care.

“Are you kidding?,” he says. “You call state agencies and you get a recording. Or someone’s not helpful. Or it’s the wrong number. . . . This is probably the hardest thing a family can go through. It defies the complexity of what people experience with children.”

Al Norman, executive director of Mass Home Care, a consumer organization for the elderly, couldn’t agree more: “I found this out personally — and I am in the business.”

When his mother needed help for his father, who had Parkinson’s disease, Norman had “a devil of a time trying to just locate an area agency on aging in Maryland. . . . We never did find the right service for overnight care.”

And John Paul Marosy, a specialist on elder care issues and president of a consulting business, HM Associates in Belmont, tells a similar tale.

“I’ve been in home care for 20 years and nothing in my professional dealings with the elder service system prepared me for the complexity and emotional impact of trying to arrange care for my own father,” says Marosy, who was moving to Massachusetts when his father was diagnosed with cancer in New Jersey.

“I would argue that for baby boomers, the next role for radical activity is making sure the elder service system works for our parents so it will work for us when we get older. This is a real wake-up call.”

And there are signs the system is beginning to wake up.

Business is booming, for instance, at Work Family Directions, Inc. in Boston, the biggest player in the “work-life industry,” which helps employees balance work and family needs.

Work Family serves 2.5 million employees nationwide from companies like Digital, Gillette and Bank of Boston, says regional manager Diane Piktialis, 30 to 40 percent of whom need help with long distance caregiving of parents. Other groups like Elderlink in Somerville and WarmLines in Newton do likewise for employees of organizations like Wellesley and Babson College.

Diana Harrington, for instance, a Babson College professor of finance who is in her fifties, turned to WarmLines to find services for her mother in Virginia and her mother and father-in-law in West Palm Beach, Fla.

Trying to set up care from afar is “horrible, terrible,” she says. “You don’t have a clue where to start. I don’t even have a West Palm Beach phone book.” But WarmLines, which works with West Suburban Elder Services, helped, she says.

Even when a parent is able to find services on her own, it may still be worthwhile to do your own research to offer additional options, says Barbara Levitov, director of special events at WGBH-TV. At the very least, says Levitov, who sought help from Elderlink, having your own suggestions can help you “start having a real conversation” with your parent.

If you don’t work for a company that provides these kinds of services, you can plunge in yourself by calling local or state agencies on aging where your parent lives.

If you’re getting nowhere and can afford it, you can hire a geriatric care manager who should come up with options much faster than you can. So far, there is no national certification for professional care managers, though most are social workers or nurses. It costs $200 to $350 for an assessment of your parent’s needs, plus $40 to $150 an hour thereafter.

Whatever you do, be gentle as you plunge into this new role with your parents — with them and yourself — say those who’ve been there. Managing a parent’s housing, medical care and finances can be a burden, especially from afar, but it is also a chance to give back or smooth over decades of troubled history.

Marosy of Belmont found it “a tremendous opportunity for closure for me in my relationship with my father, which was a very hurtful one. I grew in ways I never would have expected.”

And be persuasive, not coercive, even if your parent’s pace toward solving a seemingly messy situation is slower than yours.

In extreme cases, you can get legal guardianship of a parent — if, say, you need to sell property to pay for services. But “legal intervention may not get you what you want — what you probably need is some negotiating skills,” says Nancy Coleman, director of the American Bar Association’s commission on legal problems of the elderly.

And when the going gets tough — as it will — remember what Marosy learned, as a professional and as a son. “Think about this caregiving as an opportunity. It’s almost a dress rehearsal for your own aging.

“In terms of psychological and emotional development, this is the entree to the second half of life. We can either ignore it or embrace it.”

SIDEBAR 1

Helpful tips to remember

 

– Plan ahead. Don’t wait for a crisis — your mother’s broken hip or your father’s empty refrigerator — to get involved. And remember: As hospital stays get shorter, you may have only a few days to line up care before your parent is discharged.

– Get to know your parents’ informal network. Write down the names and phone numbers of their doctors, lawyer, minister, neighbors and friends who might be willing to help in a crunch.

– Ask your parents to spell out for you what kind of health insurance they have, including for long-term care.

– Ask if your parents would put you on their bank accounts and give you durable power of attorney so you can pay bills and contract for services if a crisis occurs.

– Ask your parents what care they want if they become disabled, especially where they want to live. Don’t assume they should move in with you or that nursing homes and assisted living are the only options. Many people can get the care they need at home — once you cut through the red tape.

– Help them write a living will or health care proxy and ask them to tell you about any other important legal matters.

– As you start to help them sort out options, don’t try to settle everything at once. It usually takes many conversations, over many visits and phone calls.

– Know your limits. Be honest about what you can and can’t do and divide tasks as fairly as possible among siblings. At a minimum, keep other close family members informed.

– As long as possible, respect your parents’ autonomy and don’t fall into the role reversal trap.

– If you get stuck trying to sort out options with your parents, bring in an outsider — a minister, doctor or family friend.

– Find out what resources and referrals are offered by your employer or your parents’ church or synagogue.

– Call the capital in the state where your parents live and ask for the state office on aging. You can also call the area agency on aging in the city or town where they live.

– Set up appointments with visiting nurses, nursing home administrators, home health aides, etc. by phone in advance to make the most of your time when you get there.

– If your parent has a specific disease, say Parkinson’s, contact the local support group. Such groups can often make referrals to helpful doctors and other services.

– Keep a logbook or a computer notebook on your parent’s status, including medical information, discussions with visiting nurses or home health aides about care at home.

Specialists in aging offer the following tips for people trying to manage the care of aging parents long distance:

SIDEBAR 2

Where to learn more

 

– Elder Care Locator, 1-800-677-1116 begin_of_the_skype_highlighting              1-800-677-1116      end_of_the_skype_highlighting.

– ElderLine, 1-800-AGE-INFO begin_of_the_skype_highlighting              1-800-AGE-INFO      end_of_the_skype_highlighting (hotline run by Mass. Home Care Corp.)

– Elderlink Inc. 617-629-0700 begin_of_the_skype_highlighting              617-629-0700      end_of_the_skype_highlighting.

– West Suburban Elder Services, 617-926-4100 begin_of_the_skype_highlighting              617-926-4100      end_of_the_skype_highlighting.

– WarmLines Parent Resources, 617-244-INFO (if service is offered by your employer).

– National Association of Geriatric Care Managers, 520-881-8008 begin_of_the_skype_highlighting              520-881-8008      end_of_the_skype_highlighting.

– Geriatric Care Managers of New England, 617-426-3533 begin_of_the_skype_highlighting              617-426-3533      end_of_the_skype_highlighting.

Books and pamphlets that may help:

– Resource Directory for Older People, free book from National Institute on Aging, 1-800-222-2225 begin_of_the_skype_highlighting              1-800-222-2225      end_of_the_skype_highlighting.

– Miles Away and Still Caring, free booklet by AARP (American Association of Retired Persons). Write to AARP Fulfillment, 601 E St., Washington, D.C., 20049. Request booklet by name and stock number D12748. Allow 6 to 8 weeks for delivery.

– “Caring for Your Aging Parents,” by Donna Cohen and Dr. Carl Eisdorfer, published by Tarcher/Putnam in New York.

– “How to Care for Aging Parents,” by Virginia Morris, published by Workman Publishing in New York.

– “What’s Next?: A Guide to Valued Aging and Other High-Wire Adventures,” by Richard Griffin, Freda Rebelsky and Radcliffe L. Romeyn Jr., published by Eldercorps Press, Cambridge, Mass.

– “You Decide: Using Living Wills and Other Advance Directives to Guide Your Treatment Choices,” by Evelyn J. Van Allen, co-published by American Hospital Publishing, Inc. and Irwin Professional Publishing.

There’s also help on line. Try

– http://www.aoa.dhhs.gov < – http://www2.ageinfo.org/naicweb/elderloc/elderloc.html < – http://www.ttrc.doleta.gov/html/family-toc-all.html (for information on the Family and Medical Leave Act of 1993)CQ

The following is a partial list of resources to help with long-distance caregiving of aging parents. Call: 

SIDEBAR 1

Helpful tips to remember

 

– Plan ahead. Don’t wait for a crisis — your mother’s broken hip or your father’s empty refrigerator — to get involved. And remember: As hospital stays get shorter, you may have only a few days to line up care before your parent is discharged.

– Get to know your parents’ informal network. Write down the names and phone numbers of their doctors, lawyer, minister, neighbors and friends who might be willing to help in a crunch.

– Ask your parents to spell out for you what kind of health insurance they have, including for long-term care.

– Ask if your parents would put you on their bank accounts and give you durable power of attorney so you can pay bills and contract for services if a crisis occurs.

– Ask your parents what care they want if they become disabled, especially where they want to live. Don’t assume they should move in with you or that nursing homes and assisted living are the only options. Many people can get the care they need at home — once you cut through the red tape.

– Help them write a living will or health care proxy and ask them to tell you about any other important legal matters.

– As you start to help them sort out options, don’t try to settle everything at once. It usually takes many conversations, over many visits and phone calls.

– Know your limits. Be honest about what you can and can’t do and divide tasks as fairly as possible among siblings. At a minimum, keep other close family members informed.

– As long as possible, respect your parents’ autonomy and don’t fall into the role reversal trap.

– If you get stuck trying to sort out options with your parents, bring in an outsider — a minister, doctor or family friend.

– Find out what resources and referrals are offered by your employer or your parents’ church or synagogue.

– Call the capital in the state where your parents live and ask for the state office on aging. You can also call the area agency on aging in the city or town where they live.

– Set up appointments with visiting nurses, nursing home administrators, home health aides, etc. by phone in advance to make the most of your time when you get there.

– If your parent has a specific disease, say Parkinson’s, contact the local support group. Such groups can often make referrals to helpful doctors and other services.

– Keep a logbook or a computer notebook on your parent’s status, including medical information, discussions with visiting nurses or home health aides about care at home.

SIDEBAR 2

Where to learn more

 

The following is a partial list of resources to help with long-distance caregiving of aging parents. Call:

– Elder Care Locator, 1-800-677-1116 begin_of_the_skype_highlighting              1-800-677-1116      end_of_the_skype_highlighting.

– ElderLine, 1-800-AGE-INFO begin_of_the_skype_highlighting              1-800-AGE-INFO      end_of_the_skype_highlighting (hotline run by Mass. Home Care Corp.)

– Elderlink Inc. 617-629-0700 begin_of_the_skype_highlighting              617-629-0700      end_of_the_skype_highlighting.

– West Suburban Elder Services, 617-926-4100 begin_of_the_skype_highlighting              617-926-4100      end_of_the_skype_highlighting.

– WarmLines Parent Resources, 617-244-INFO (if service is offered by your employer).

– National Association of Geriatric Care Managers, 520-881-8008 begin_of_the_skype_highlighting              520-881-8008      end_of_the_skype_highlighting.

– Geriatric Care Managers of New England, 617-426-3533 begin_of_the_skype_highlighting              617-426-3533      end_of_the_skype_highlighting.

Books and pamphlets that may help:

– Resource Directory for Older People, free book from National Institute on Aging, 1-800-222-2225 begin_of_the_skype_highlighting              1-800-222-2225      end_of_the_skype_highlighting.

– Miles Away and Still Caring, free booklet by AARP (American Association of Retired Persons). Write to AARP Fulfillment, 601 E St., Washington, D.C., 20049. Request booklet by name and stock number D12748. Allow 6 to 8 weeks for delivery.

– “Caring for Your Aging Parents,” by Donna Cohen and Dr. Carl Eisdorfer, published by Tarcher/Putnam in New York.

– “How to Care for Aging Parents,” by Virginia Morris, published by Workman Publishing in New York.

– “What’s Next?: A Guide to Valued Aging and Other High-Wire Adventures,” by Richard Griffin, Freda Rebelsky and Radcliffe L. Romeyn Jr., published by Eldercorps Press, Cambridge, Mass.

– “You Decide: Using Living Wills and Other Advance Directives to Guide Your Treatment Choices,” by Evelyn J. Van Allen, co-published by American Hospital Publishing, Inc. and Irwin Professional Publishing.

There’s also help on line. Try

– http://www.aoa.dhhs.gov < – http://www2.ageinfo.org/naicweb/elderloc/elderloc.html < – http://www.ttrc.doleta.gov/html/family-toc-all.html (for information on the Family and Medical Leave Act of 1993)CQ

Specialists in aging offer the following tips for people trying to manage the care of aging parents long distance: