Arquivo da tag: Envelhecimento

Can you think yourself young? (The Guardian)

David Robson, Sun 2 Jan 2022 12.00 GMT

Illustration by Observer design/Getty/Freepik.

Research shows that a positive attitude to ageing can lead to a longer, healthier life, while negative beliefs can have hugely detrimental effects

For more than a decade, Paddy Jones has been wowing audiences across the world with her salsa dancing. She came to fame on the Spanish talent show Tú Sí Que Vales (You’re Worth It) in 2009 and has since found success in the UK, through Britain’s Got Talent; in Germany, on Das Supertalent; in Argentina, on the dancing show Bailando; and in Italy, where she performed at the Sanremo music festival in 2018 alongside the band Lo Stato Sociale.

Jones also happens to be in her mid-80s, making her the world’s oldest acrobatic salsa dancer, according to Guinness World Records. Growing up in the UK, Jones had been a keen dancer and had performed professionally before she married her husband, David, at 22 and had four children. It was only in retirement that she began dancing again – to widespread acclaim. “I don’t plead my age because I don’t feel 80 or act it,” Jones told an interviewer in 2014.

According to a wealth of research that now spans five decades, we would all do well to embrace the same attitude – since it can act as a potent elixir of life. People who see the ageing process as a potential for personal growth tend to enjoy much better health into their 70s, 80s and 90s than people who associate ageing with helplessness and decline, differences that are reflected in their cells’ biological ageing and their overall life span.

Salsa dancer Paddy Jones, centre.
Salsa dancer Paddy Jones, centre. Photograph: Alberto Teren

Of all the claims I have investigated for my new book on the mind-body connection, the idea that our thoughts could shape our ageing and longevity was by far the most surprising. The science, however, turns out to be incredibly robust. “There’s just such a solid base of literature now,” says Prof Allyson Brothers at Colorado State University. “There are different labs in different countries using different measurements and different statistical approaches and yet the answer is always the same.”

If I could turn back time

The first hints that our thoughts and expectations could either accelerate or decelerate the ageing process came from a remarkable experiment by the psychologist Ellen Langer at Harvard University.

In 1979, she asked a group of 70- and 80-year-olds to complete various cognitive and physical tests, before taking them to a week-long retreat at a nearby monastery that had been redecorated in the style of the late 1950s. Everything at the location, from the magazines in the living room to the music playing on the radio and the films available to watch, was carefully chosen for historical accuracy.

The researchers asked the participants to live as if it were 1959. They had to write a biography of themselves for that era in the present tense and they were told to act as independently as possible. (They were discouraged from asking for help to carry their belongings to their room, for example.) The researchers also organised twice-daily discussions in which the participants had to talk about the political and sporting events of 1959 as if they were currently in progress – without talking about events since that point. The aim was to evoke their younger selves through all these associations.

To create a comparison, the researchers ran a second retreat a week later with a new set of participants. While factors such as the decor, diet and social contact remained the same, these participants were asked to reminisce about the past, without overtly acting as if they were reliving that period.

Most of the participants showed some improvements from the baseline tests to the after-retreat ones, but it was those in the first group, who had more fully immersed themselves in the world of 1959, who saw the greatest benefits. Sixty-three per cent made a significant gain on the cognitive tests, for example, compared to just 44% in the control condition. Their vision became sharper, their joints more flexible and their hands more dextrous, as some of the inflammation from their arthritis receded.

As enticing as these findings might seem, Langer’s was based on a very small sample size. Extraordinary claims need extraordinary evidence and the idea that our mindset could somehow influence our physical ageing is about as extraordinary as scientific theories come.

Becca Levy, at the Yale School of Public Health, has been leading the way to provide that proof. In one of her earliest – and most eye-catching – papers, she examined data from the Ohio Longitudinal Study of Aging and Retirement that examined more than 1,000 participants since 1975.

The participants’ average age at the start of the survey was 63 years old and soon after joining they were asked to give their views on ageing. For example, they were asked to rate their agreement with the statement: “As you get older, you are less useful”. Quite astonishingly, Levy found the average person with a more positive attitude lived on for 22.6 years after the study commenced, while the average person with poorer interpretations of ageing survived for just 15 years. That link remained even after Levy had controlled for their actual health status at the start of the survey, as well as other known risk factors, such as socioeconomic status or feelings of loneliness, which could influence longevity.

The implications of the finding are as remarkable today as they were in 2002, when the study was first published. “If a previously unidentified virus was found to diminish life expectancy by over seven years, considerable effort would probably be devoted to identifying the cause and implementing a remedy,” Levy and her colleagues wrote. “In the present case, one of the likely causes is known: societally sanctioned denigration of the aged.”

Later studies have since reinforced the link between people’s expectations and their physical ageing, while dismissing some of the more obvious – and less interesting – explanations. You might expect that people’s attitudes would reflect their decline rather than contribute to the degeneration, for example. Yet many people will endorse certain ageist beliefs, such as the idea that “old people are helpless”, long before they should have started experiencing age-related disability themselves. And Levy has found that those kinds of views, expressed in people’s mid-30s, can predict their subsequent risk of cardiovascular disease up to 38 years later.

The most recent findings suggest that age beliefs may play a key role in the development of Alzheimer’s disease. Tracking 4,765 participants over four years, the researchers found that positive expectations of ageing halved the risk of developing the disease, compared to those who saw old age as an inevitable period of decline. Astonishingly, this was even true of people who carried a harmful variant of the APOE gene, which is known to render people more susceptible to the disease. The positive mindset can counteract an inherited misfortune, protecting against the build-up of the toxic plaques and neuronal loss that characterise the disease.

How could this be?

Behaviour is undoubtedly important. If you associate age with frailty and disability, you may be less likely to exercise as you get older and that lack of activity is certainly going to increase your predisposition to many illnesses, including heart disease and Alzheimer’s.

Importantly, however, our age beliefs can also have a direct effect on our physiology. Elderly people who have been primed with negative age stereotypes tend to have higher systolic blood pressure in response to challenges, while those who have seen positive stereotypes demonstrate a more muted reaction. This makes sense: if you believe that you are frail and helpless, small difficulties will start to feel more threatening. Over the long term, this heightened stress response increases levels of the hormone cortisol and bodily inflammation, which could both raise the risk of ill health.

The consequences can even be seen within the nuclei of the individual cells, where our genetic blueprint is stored. Our genes are wrapped tightly in each cell’s chromosomes, which have tiny protective caps, called telomeres, which keep the DNA stable and stop it from becoming frayed and damaged. Telomeres tend to shorten as we age and this reduces their protective abilities and can cause the cell to malfunction. In people with negative age beliefs, that process seems to be accelerated – their cells look biologically older. In those with the positive attitudes, it is much slower – their cells look younger.

For many scientists, the link between age beliefs and long-term health and longevity is practically beyond doubt. “It’s now very well established,” says Dr David Weiss, who studies the psychology of ageing at Martin-Luther University of Halle-Wittenberg in Germany. And it has critical implications for people of all generations.

Birthday cards sent to Captain Tom Moore for his 100th birthday
Birthday cards sent to Captain Tom Moore for his 100th birthday – many cards for older people have a less respectful tone. Photograph: Shaun Botterill/Getty Images

Our culture is saturated with messages that reinforce the damaging age beliefs. Just consider greetings cards, which commonly play on of images depicting confused and forgetful older people. “The other day, I went to buy a happy 70th birthday card for a friend and I couldn’t find a single one that wasn’t a joke,” says Martha Boudreau, the chief communications officer of AARP, a special interest group (formerly known as the American Association of Retired Persons) that focuses on the issues of over-50s.

She would like to see greater awareness – and intolerance – of age stereotypes, in much the same way that people now show greater sensitivity to sexism and racism. “Celebrities, thought leaders and influencers need to step forward,” says Boudreau.

In the meantime, we can try to rethink our perceptions of our own ageing. Various studies show that our mindsets are malleable. By learning to reject fatalistic beliefs and appreciate some of the positive changes that come with age, we may avoid the amplified stress responses that arise from exposure to negative stereotypes and we may be more motivated to exercise our bodies and minds and to embrace new challenges.

We could all, in other words, learn to live like Paddy Jones.

When I interviewed Jones, she was careful to emphasise the potential role of luck in her good health. But she agrees that many people have needlessly pessimistic views of their capabilities, over what could be their golden years, and encourages them to question the supposed limits. “If you feel there’s something you want to do, and it inspires you, try it!” she told me. “And if you find you can’t do it, then look for something else you can achieve.”

Whatever our current age, that’s surely a winning attitude that will set us up for greater health and happiness for decades to come.

This is an edited extract fromThe Expectation Effect: How your Mindset Can Transform Your Life by David Robson, published by Canongate on 6 January (£18.99).

Why Are Elderly Duped? Area in Brain Where Doubt Arises Changes With Age (Science Daily)

ScienceDaily (Aug. 16, 2012) — Everyone knows the adage: “If something sounds too good to be true, then it probably is.” Why, then, do some people fall for scams and why are older folks especially prone to being duped?

An answer, it seems, is because a specific area of the brain has deteriorated or is damaged, according to researchers at the University of Iowa. By examining patients with various forms of brain damage, the researchers report they’ve pinpointed the precise location in the human brain, called the ventromedial prefrontal cortex, that controls belief and doubt, and which explains why some of us are more gullible than others.

“The current study provides the first direct evidence beyond anecdotal reports that damage to the vmPFC (ventromedial prefrontal cortex) increases credulity. Indeed, this specific deficit may explain why highly intelligent vmPFC patients can fall victim to seemingly obvious fraud schemes,” the researchers wrote in the paper published in a special issue of the journal Frontiers in Neuroscience.

A study conducted for the National Institute of Justice in 2009 concluded that nearly 12 percent of Americans 60 and older had been exploited financially by a family member or a stranger. And, a report last year by insurer MetLife Inc. estimated the annual loss by victims of elder financial abuse at $2.9 billion.

The authors point out their research can explain why the elderly are vulnerable.

“In our theory, the more effortful process of disbelief (to items initially believed) is mediated by the vmPFC, which, in old age, tends to disproportionately lose structural integrity and associated functionality,” they wrote. “Thus, we suggest that vulnerability to misleading information, outright deception and fraud in older adults is the specific result of a deficit in the doubt process that is mediated by the vmPFC.”

The ventromedial prefrontal cortex is an oval-shaped lobe about the size of a softball lodged in the front of the human head, right above the eyes. It’s part of a larger area known to scientists since the extraordinary case of Phineas Gage that controls a range of emotions and behaviors, from impulsivity to poor planning. But brain scientists have struggled to identify which regions of the prefrontal cortex govern specific emotions and behaviors, including the cognitive seesaw between belief and doubt.

The UI team drew from its Neurological Patient Registry, which was established in 1982 and has more than 500 active members with various forms of damage to one or more regions in the brain. From that pool, the researchers chose 18 patients with damage to the ventromedial prefrontal cortex and 21 patients with damage outside the prefrontal cortex. Those patients, along with people with no brain damage, were shown advertisements mimicking ones flagged as misleading by the Federal Trade Commission to test how much they believed or doubted the ads. The deception in the ads was subtle; for example, an ad for “Legacy Luggage” that trumpets the gear as “American Quality” turned on the consumer’s ability to distinguish whether the luggage was manufactured in the United States versus inspected in the country.

Each participant was asked to gauge how much he or she believed the deceptive ad and how likely he or she would buy the item if it were available. The researchers found that the patients with damage to the ventromedial prefrontal cortex were roughly twice as likely to believe a given ad, even when given disclaimer information pointing out it was misleading. And, they were more likely to buy the item, regardless of whether misleading information had been corrected.

“Behaviorally, they fail the test to the greatest extent,” says Natalie Denburg, assistant professor in neurology who devised the ad tests. “They believe the ads the most, and they demonstrate the highest purchase intention. Taken together, it makes them the most vulnerable to being deceived.” She added the sample size is small and further studies are warranted.

Apart from being damaged, the ventromedial prefrontal cortex begins to deteriorate as people reach age 60 and older, although the onset and the pace of deterioration varies, says Daniel Tranel, neurology and psychology professor at the UI and corresponding author on the paper. He thinks the finding will enable doctors, caregivers, and relatives to be more understanding of decision making by the elderly.

“And maybe protective,” Tranel adds. “Instead of saying, ‘How would you do something silly and transparently stupid,’ people may have a better appreciation of the fact that older people have lost the biological mechanism that allows them to see the disadvantageous nature of their decisions.”

The finding corroborates an idea studied by the paper’s first author, Erik Asp, who wondered why damage to the prefrontal cortex would impair the ability to doubt but not the initial belief as well. Asp created a model, which he called the False Tagging Theory, to separate the two notions and confirm that doubt is housed in the prefrontal cortex.

“This study is strong empirical evidence suggesting that the False Tagging Theory is correct,” says Asp, who earned his doctorate in neuroscience from the UI in May and is now at the University of Chicago.

Kenneth Manzel, Bryan Koestner, and Catherine Cole from the UI are contributing authors on the paper. The National Institute on Aging and the National Institute of Neurological Disorders and Stroke funded the research.

Aumento da expectativa de vida faz surgir novos problemas nas pessoas com deficiência mental (FAPESP)

Pesquisa FAPESP
Edição 189 – Novembro 2011

Ciência > Envelhecimento
O preço da longevidade

Carlos Fioravanti

As pessoas com deficiência intelectual, que há 40 anos morriam na adolescência, hoje podem viver mais de 60 anos. Como estão vivendo mais, outros problemas orgânicos estão surgindo. Reunidos durante dois dias em agosto na Associação de Paes e Amigos dos Excepcionais (Apae) de São Paulo, médicos e pesquisadores da Universidade Federal de São Paulo (Unifesp) e da Universidade de São Paulo (USP), psicólogos, terapeutas, advogados, assistentes sociais e outros profissionais da saúde reconheceram um dos graves problemas emergentes, a possibilidade de envelhecimento precoce.

Em um levantamento preliminar feito em 2009 em seis instituições da cidade de São Paulo, de um grupo de 373 pessoas com deficiência intelectual (ou DI; a expressão deficiência mental não é mais recomendada) e mais de 30 anos de idade, 192 apresentavam pelo menos três sinais de provável envelhecimento precoce, de acordo com um questionário que avaliava eventuais perdas de memória, de autonomia nas tarefas do dia a dia, de interesse por atividades ou de visão e audição. Para dimensionar esse problema, está sendo preparado um levantamento mais abrangente e detalhado, com cerca de 500 pessoas com DI e idade entre 30 e 59 anos da Grande São Paulo.

Os estudos em andamento são essenciais para “vermos o que pode ser feito, em termos de atendimento médico e de políticas públicas”, diz Regina Leondarides, coordenadora do grupo de estudo de envelhecimento precoce das pessoas com deficiência intelectual, que reúne 10 instituições de atendimento. “Temos muitas políticas de saúde voltadas para a criança, mas as políticas para o envelhecimento estão começando a ser construídas”, comenta Esper Cavalheiro, professor da Unifesp e presidente do conselho científico do Instituto Apae de São Paulo. “Estamos atrasados, em vista do envelhecimento acelerado da população brasileira.”

Um estudo da Espanha publicado em 2008 indicou que as pessoas com DI envelhecem prematuramente – as com síndrome de Down, de modo mais intenso. Para chegar a essas conclusões, os pesquisadores acompanharam a saúde de 238 pessoas com DI e mais de 40 anos de idade durante cinco anos. Não se trata, aparentemente, de um fenômeno inevitável. O envelhecimento precoce das pessoas com DI leve e moderada resulta da falta de programas de promoção de saúde e do acesso reduzido a serviços médicos e sociais. As pessoas com DI se mostraram com maior tendência à obesidade (apenas 25% tinham peso considerado normal), à hipertensão arterial (25% do total) e a distúrbios metabólicos, como diabetes e hipotireoidismo (10% do total).

“O envelhecimento precoce, se confirmado, pode ter causas genéticas ou ambientais, independentemente da deficiência intelectual”, comenta Dalci Santos, gerente do Instituto Apae de São Paulo. Matemática de formação, com doutorado em andamento na Unifesp, ela acrescenta: “Não conseguiremos avançar muito até esclarecermos melhor a origem das deficiências intelectuais”. As causas podem ser genéticas, como na síndrome de Down, ou ambientais (causas não genéticas), incluindo infecções, baixa oxigenação do cérebro do feto, alcoolismo, radiação, intoxicação por chumbo durante a gravidez ou prematuridade – muitas vezes, vários fatores em conjunto.

Causas ambientais ou genéticas
Em um artigo no primeiro número da Revista de Deficiência Intelectual DI, publicação do Instituto Apae lançada em outubro, João Monteiro de Pina-Neto, médico geneticista da Faculdade de Medicina de Ribeirão Preto da USP, apresenta os resultados de um estudo sobre as causas da deficiência intelectual em 200 pessoas atendidas nas Apaes de Altinópolis e Serrana, dois municípios da região de Ribeirão Preto. Esse estudo faz parte de um levantamento maior, com cerca de mil pessoas com DI atendidas em quatro Apaes, que Pina-Neto e sua equipe pretendem concluir em meados de 2012. Os resultados obtidos até agora indicam o predomínio de causas ambientais (42,5% do total), seguidas pelas genéticas (29%) e indeterminadas (20%).

Um estudo similar feito com 10 mil pessoas na Carolina do Sul, Estados Unidos, apresentou o mesmo percentual de causas genéticas, mas apenas 18% de causas ambientais e 56% de causas desconhecidas. Alguns contrastes chamam a atenção. Enquanto a deficiência intelectual causada por falta de oxigenação cerebral responde por 5% do total das causas de DI nos Estados Unidos, em São Paulo é 16,5%; a prematuridade, de 5% nos Estados Unidos, foi de 14,5% no estudo paulista; o efeito das infecções, de 5%, é quase o dobro aqui, 9%.

A conclusão que emerge dessa comparação é que o número de nascimentos de bebês com DI poderia ser reduzido por meio de algumas medidas preventivas. “Melhorar o atendimento pré-natal e a qualidade do parto são uma prioridade”, ressalta Pina-Neto. “Ainda temos casos de deficiência causada por sífilis, rubéola ou toxoplasmose contraída durante a gestação e meningites pós-natais”, lamenta. Segundo ele, outro problema que pode ser controlado é o alcoolismo. “De 20% a 30% das mulheres da região de Ribeirão Preto consomem bebida alcoólica em excesso e, como resultado, de cada 100 gravidezes, nasce uma criança com DI causada por síndrome alcoólica fetal”, diz ele. “Não fazemos ainda a adequada prevenção das causas da deficiência intelectual.”

As causas genéticas podem ser controladas, já que o risco de uma criança nascer com síndrome de Down aumenta muito com a idade dos pais. “As mulheres estão tendo filhos após os 35 anos de idade, portanto mais propen­sas a terem filhos com Down, e os homens estão se casando várias vezes, tendo filhos em cada ca­samento”, diz Pina-Neto. Segundo ele, homens estéreis que procuram as clínicas de reprodução deveriam ser mais informados sobre a possibilidade de terem alterações genéticas que podem ser transmitidas aos filhos caso se tornem férteis.

As pessoas com DI apresentam capacidade de raciocínio bastante abaixo da média e limitações para aprender, se cuidar ou se comunicar com outras, mas atualmente são muito mais integradas socialmente, autônomas e produtivas, com mais oportunidades para expressar a criatividade do que há algumas décadas. Frequentam escolas regulares, com outras crianças e adultos, participam de competições esportivas e conquistam mais postos de mercado de trabalho. Crianças e adultos com DI não vão mais à Apae de São Paulo para aprender todo dia, mas aparecem algumas vezes por semana para atendimento educacional especializado ou para consultas médicas. O serviço de apoio ao envelhecimento atende 132 pessoas com idade entre 30 e 67 anos.

Ainda há muitas dúvidas sobre como lidar com os novos problemas. Crianças e adultos com de­­­­ficiência precisam de hábitos e horários para se sentir calmos e confortáveis. Ao mesmo tempo, hábitos imutáveis podem favorecer o surgimento da doença de Alzheimer, doença neurológi­ca que se agrava com o envelhecimento. Vem daí um impasse: manter a rotina inalterada poderia alimentar a propensão ao Alzheimer, mas quebrar a rotina pode ser perturbador.

Propensão ao alzheimer
O cérebro das pessoas com Down pode exibir um dos sinais típicos do Alzheimer: o acúmulo de placas amiloides, que dificultam o funcionamento adequado dos neurônios. Uma equipe da Universidade da Califórnia em Los Angeles, Estados Unidos, encontrou placas amiloides em quantidade mais elevada no cérebro de pessoas com Down do que em pessoas com Alzheimer já diagnosticado e em pessoas normais.

“Os sinais biológicos de Alzheimer podem surgir antes dos sinais clínicos”, observa Orestes Forlenza, professor da Faculdade de Medicina da USP. “Ter amiloide não significa ter demência futura. Qual a melhor intervenção futura? Não sabemos. Talvez via nutrição ou atividade física seja mais seguro do que por medicamentos.” Ira Lott e sua equipe da Universidade da Califórnia em Irvine fizeram um estudo duplo-cego durante dois anos com 53 pessoas com síndrome de Down para ver se a complementação da dieta com compostos antioxidantes poderia melhorar o funcionamento mental ou estabilizar a perda da capacidade cognitiva. Os resultados, publicados em agosto na American Journal of Medical Genetics, indicaram que não.

Esper Cavalheiro apresentou três perguntas ainda sem resposta. De que modo as alterações próprias do envelhecimento, como as doenças cardiovasculares, diabetes e câncer, se apresentam nas pessoas com DI? Como alterações frequentes nessas pessoas, a exemplo de demências e osteoporose, se comportam no envelhecimento? Os medicamentos usados para tratar hipertensão, diabetes e outras doenças típicas do envelhecimento funcionam nas pessoas com DI do mesmo modo que em outros indivíduos?

Outra dúvida: as estratégias de controle dos fatores de risco de doenças cardiovasculares recomendadas para pessoas normais, como o estímulo a atividades físicas, têm o mesmo impacto sobre a saúde das pessoas com e sem deficiência intelectual? “Supomos que sim, mas não sabemos ao certo”, diz Ricardo Nitrini, da USP.

Segundo Cavalheiro, as pessoas com DI com 65 anos ou mais correspondiam a 4% da população total no Censo de 2000; hoje respondem por 5,5% da população total. “Não podemos nos contentar apenas com estatísticas e diagnósticos”, alerta. “Temos de enfrentar esse problema com rapidez. Quanto mais gente dialogando e pensando nesses problemas, melhor.”