News Release

Study shows restricted activities predict decline; UNC physician urges acceptance of the inevitable

Peer-Reviewed Publication

University of North Carolina at Chapel Hill

CHAPEL HILL -- For older people not otherwise at high risk of disabilities that cut into their daily life, restricted activities they experience are an important predictor of functional decline and not just a benign feature of old age, a new study concludes.

Old people and their loved ones -- and doctors -- need to accept the inevitability of that decline while tempering the journey with friendship and love, says a noted University of North Carolina at Chapel Hill physician often asked to comment on medical issues.

The study, conducted by Dr. Thomas M. Gill of Yale University and colleagues on 680 non-institutionalized people living in New Haven, Conn., showed that disability scores that people aged 70 and older received after being evaluated worsened by 11.2 percent for every month in which their activities were curtailed by illness, injury or other problems.

The association between restricted activity and functional decline differed significantly in two of the three risk groups studied. For the low- and intermediate-risk groups, adjusted disability scores increased by 18.7 percent and 7.5 percent, respectively, for each additional month of impairment.

"Our results indicate that restricted activity for most older persons represents more than just having a bad day," Gill wrote. "Given its high incidence and strong association with functional decline, restricted activity warrants further investigation as a potential target of preventive and restorative interventions."

A report on the findings appears in the current (June 9) issue of the Archives of Internal Medicine, an American Medical Association journal.

In an accompanying editorial written at the journal's request, Dr. Nortin M. Hadler, professor of medicine at the UNC School of Medicine, called the Yale study "elegant" but suggested that people should adopt more realistic attitudes about old age and about what modern medicine can and cannot accomplish. Hadler is a rheumatologist with research interest in disabling regional musculoskeletal ailments.

"Fortunate, indeed, are the octogenarians of today who have the wits and faculties to contend with life's demands," he wrote. "They are enjoying years beyond many of their birth cohort. None is deluded as to the inevitability of demise. Can they continue to function highly till death removes the challenge?"

The short answer for most people, as documented by the new study, is no.

"The higher level of functional capacity is ephemeral; it is to be whittled away," Hadler wrote. "Month by month they will find themselves faced with days when they, not up to performing as usual, even feel the need to take to bed. Inexorably, activities of daily living, activities they always took for granted, become insurmountable challenges. They will come to take their place among the frail elderly."

Their path inevitably leads in one direction and toward a single and final destination -- the grave.

"Can't we interpose the marvelous fruits of our science between the high-functioning octogenarians and this fate?" he said. "... Can we mobilize modern biology to repair some of their frays? Possibly. But I doubt that any such effort will matter."

The likelihood that contemporary science can shepherd more of the high-functioning octogenarians into the meager ranks of the high-functioning nonagenarians is more meager yet, the UNC physician said.

"I would rather we learn to better support these octogenarians through the transition toward decrepitude and comfort them in the final passage. Friendship and love are defensible as both prescriptions and clinical interventions. To advocate otherwise is to harbor delusions of immortality. I am convinced that heroic efforts on behalf of the highly functioning octogenarians will accomplish little of substance."

His views do not mean he advocates therapeutic nihilism -- not supporting appropriate therapies for old people, the physician said.

"It is the invoking of the age-old art of medicine to contend with the reality of our aging and of our mortality," he wrote. "When the high-functioning octogenarian suffers the doldrums and progresses in decrepitude, it is because his or her time is nearing. When death supervenes, it is because it is one's time. That is the proximate cause of death. It does not matter how many diseases are vying for coup de grace. It only matters that the journey was as gratifying as possible."

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By DAVID WILLIAMSON
UNC News Services

Note: Hadler can be reached at 919-966-0566 or nmh@med.unc.edu. Gill can be reached via e-mail at gill@nyhh.org.


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