Seeking New Lives for Aged

A few tiny, halting steps down a linoleum hallway. Slow motion pushing up from a chair. The breathless effort of balancing against a metal walker.

These may be the stuff of new lives for those in the twilight of their days, say doctors researching the effects of exercise on the very old.

At several nursing homes in the San Fernando Valley, researchers are urging some residents once thought to be nearly immobile to raise their arms, or stand and walk on their trembling legs. The hope is that by exercising, even people past age 100 can improve their lives and health.

“People have the assumption when they look at these people that they are lost causes,” said Jack Schnelle, director of the Reseda-based Borun Center for Gerontological Research. “ . . . but can it be better? Is it hopeless?”

Schnelle and his colleagues are part of a small group of researchers seeking to transform what seems the most inescapable of life’s burdens--the decrepitude of old age.

Some of their findings are challenging the notion that growing old means a slow slide into helplessness.

They believe much of the frailty associated with old age is preventable. Old people lose the use of their muscles for the same reason weightless astronauts and bedridden hospital patients do, they contend.

“It’s very clear that a lot of what we think is inevitable aging is in fact disuse,” said Maria Fiatarone, assistant professor of Harvard Medical School’s division on aging who has conducted pioneering studies on the effects of exercise on the elderly.

Not prolonging life, but sharpening its quality is the aim of the new research--a purpose that sets it apart from more traditional health-prevention studies, said Priscilla Gilliam MacRae, a member of the Borun Center team and associate professor of sports medicine at Pepperdine University.

And Schnelle said the research also may have implications for a pressing national problem--the soaring costs of health care for the very old.

As a group, people 85 and older incur the highest health-care costs of any age group, and their number is growing disproportionately to the rest of the population, said Richard Suzman, director of the office of demography with the National Institute on Aging, a part of the National Institutes of Health.

This group of older elderly comprises only 1.2% of the population, Suzman said. Their numbers will grow to about 5% by the middle of the next century, according to U.S. Census data.

Average health expenditures for older retirees who use health care are about twice as high as costs for younger elderly, those 65 to 74, said Susan Raetzman, analyst for the American Assn. of Retired Persons.

Nevertheless, bedridden, frail or demented nursing home residents have been thrust to the fringes of medical research, Schnelle contends.

“Everyone for years has ignored chronic, long-term nursing home patients. People thought you couldn’t do anything about them. . . . But these people cost more than anyone else. They don’t die right away.”

His colleague Joseph Ouslander, geriatrician and associate professor at the UCLA medical school, said living longer may not be the desire of many of the thousands of people in nursing homes.

“The question is are we just going to let them sit there, saying ‘I want to die.’. . . . Or do we do something with them?” Ouslander said.

Three exercise studies are now being conducted by the Borun Center, a joint venture between the Jewish Home for the Aging of Greater Los Angeles and the Multi Campus Division of Geriatrics and Gerontology at UCLA.

In one study, funded by a private $25,000 Borun Center grant, about 40 nursing home residents are taking part in a regular walking regimen.

The oldest participant is 106 years old. The average age is about 92, Schnelle said. What they all have in common is a lifestyle that keeps them lying or sitting for most of their days.

A few times a week, for eight weeks, the residents are walked individually. With small, painful steps, usually leaning on a cane or a walker, the residents walked an average of about eight minutes at a time, Schnelle said.

At the end of the eight weeks, their average walking time had risen to 20 minutes.

“That would be like a younger person running three to four miles,” Schnelle said. “It’s a significant walk for these people.”

Roslyn Cellucci, at 83 one of the youngest participants in the study, uses a walker to complete her workouts.

“I walk all across the grounds now, unless I feel cramps coming on,” she said, settling back into a chair after a 10-minute exertion. “Today I was not even tired.”

The subjects of the second study are those individuals where a walk of even five minutes might be too much. They are the supposed “lost causes” of whom Schnelle speaks.

Residents who spend much of their lives in restraints--with most suffering from some form of dementia--are encouraged to walk a few steps, or wheel themselves if they are in a wheelchair. Those who can are trying their hands at rowing on a specially designed machine three times a week, said Sandi Simmons, a member of the research team whose field, like Schnelle’s, is psychology.

A final study focuses on very frail and incontinent elderly (including bedridden individuals) who are encouraged to do a variety of what’s called “incidental” exercises--muscle movements that are necessary for incidental tasks of daily life. These elderly struggle to stand up from a chair to a walker, or just to raise their arms, Simmons said.

So far, Schnelle said the most noticeable effect of the exercise has been endurance, where clear improvement has been observed. Less clear is whether the hoped-for effects on appetite, sleep habits and depression are taking place, he said. The studies will not be complete for several months, and the results not published until later.

Fiatarone, the Harvard researcher, is the author of one of a handful of studies published in recent years on exercise and the frail elderly. Her pioneering 1990 study of the effects of weight-lifting on people 86 to 96 concluded that even at 90 and older, strength could be improved dramatically through exercise.

Fiatarone has just completed another study of about 100 nursing home residents whose average age is 89. She said the research, which again emphasized weight-lifting, showed that high-intensity exercise could yield dramatic health benefits in the old.

But Fiatarone said the few other studies conducted in this area have cast doubt on whether low-level exercise would have any significant effect.

In Reseda, the elderly involved in the Borun Center studies are too frail and confused to even begin a weight-training program, Ouslander said. By their standards, even small amounts of movement are strenuous, he said.

Although researchers are far from knowing the broad implications of improving the degree of endurance and mobility in the elderly, Ouslander maintains that--theoretically, at least--exercise could have a significant impact on the way people grow old.

Better balance and mobility could mean fewer falls, he said.

Increased lung capacity could mean greater resistance to pneumonia, a common affliction of the elderly. And greater strength could mean nursing home residents could do more on their own, easing the burden on nursing home staff members.

All this could mean lower medical costs, Ouslander said. As well as a different path to death, according to MacRae, Ouslander’s colleague.

“Do you have to get fatter and slower and lose your memory?” MacRae asked, adding that the group’s research may show a gentler path to death is possible.

That’s really what most people want, MacRae said.

“To play tennis until you’re 90, then just die.”