When Dorothy Newcombe fell ill with heart disease at the age of 92, her family
thought she had reached the end of her natural lifespan. One of her seven
grandchildren and one of her seven great-grandchildren travelled from New
Zealand to say goodbye.
After a new treatment particularly targeted at the elderly, Dorothy is still
going strong. She goes shopping with her 94-year-old husband, George, does
the housework and is back playing bingo at the local church hall. Dorothy,
from Liver-pool, has even managed to dance a few steps of a waltz again.
For any nonagenarian to have a new heart valve is remarkable; what makes
Dorothy’s case even more special is that she received one in a procedure
that allowed her to walk out of hospital just three days after surgery last
October.
Last week she said: “Before the operation I wasn’t at all well. I couldn’t
walk, I couldn’t bend down. This operation has given me a new lease of life.
It has given me a new chance. We can still put on records and have a dance
in the house.”
Like several other patients in their nineties, she benefited from an operation
called Tavi - trans-catheter aortic valve implantation - which is far less
invasive than previous techniques. It is specifically offered to elderly
patients who would not be robust enough to survive traditional open-heart
surgery.
The oldest British patient to have undergone the procedure so far was 94 and
doctors believe it will allow patients who would have died within a couple
of years to reach 100.
At the same time other advances are offering a new lease of active healthy
life to the middle-aged. Authors of a new study into the “polypill”, a
combination of five drugs, say the treatment could potentially halve the
number of heart attacks and strokes among the middle-aged.
The polypill contains aspirin, a statin (which reduces cholesterol levels) and
three drugs that lower blood pressure. In a trial in India of more than 2000
people aged between 45 and 80 who were at risk of developing heart disease,
researchers found that the blood pressure component could reduce heart
disease by 24% and strokes by 33%. They found the cholesterol lowering
ingredients could potentially cut heart disease by 27% and strokes by 8%.
The authors, who published their findings in The Lancet, believe that the
combined effects could potentially bring about a 50% cut in heart attacks
and strokes.
Such advances promise to push back the frontiers of healthy life. For those
who keep fit it is remarkable what can be achieved - as demonstrated by
Lauren Hutton, the model. She is 65 yet still in demand by leading
designers. Not everyone can look so good, of course, but doctors believe
that new treatments and healthy lifestyles are extending middle age even
further.
David Metz, visiting professor at the Centre for Ageing and Public Health at
the London School of Hygiene & Tropical Medicine and co-author of the
book Older, Richer, Fitter, believes that we are now extending middle age up
to 70 or 80 with the elderly stage following on later.
“Life expectancy is increasing. I would be quite optimistic. It is an exciting
time. What are the prospects of medical and scientific advances, giving an
average increase in life expectancy of five years, emerging in the next five
years? Hard to say, but probably quite reasonable,” Metz said.
“There is a debate about whether these are healthy years or unhealthy years.
My general take on this is that we are adding years of middle age into the
middle of the life course and the years of ill health at the end have been
pushed back in time.” THE less invasive heart valve replacement operation is
the latest in a series of life-extending advances. It involves threading a
replacement valve up to the heart using a catheter inserted into the top of
the leg.
Dorothy’s doctor, Rod Stables, a consultant cardiologist at the Liver-pool
Heart and Chest hospital, argues that his elderly patients would not have
made it through conventional open heart surgery. He explained what that
entails: “An incision is made in the skin over the centre of the breast
bone. The breast bone is then divided through its centre with a pneumatic
saw, almost like a Black & Decker; you crank open the sternum exposing
the heart, you then make an incision around the aortic valve, surgically
remove the ageing natural valve and stitch in a new one.”
The Tavi procedure is far less stressful. “What makes Tavi so special is that
it offers treatment to patients who currently have no other option,” Stables
said.
The less invasive procedure is being carried out in elderly patients at
leading heart centres across Britain. Dr Michael Mullen, consultant
cardiologist at the Royal Brompton hospital in London, has reported that 66
patients have been treated at his unit in the past two years. The average
patient was 79.
Other procedures are also extending active life. The application of stents,
tiny wire mesh tubes that act like small scaffolds to keep the arteries
open, has been one of the greatest breakthroughs offering an alternative to
heart by-pass operations. Like the heart valves, the stents are threaded up
to the heart using a catheter inserted into the groin.
Statins, a central component of the polypill, reducing cholesterol which would
otherwise clog up the arteries, are another important advance in the field,
saving thousands of lives every year.
Elderly patients are also becoming mobile thanks to advances in orthopaedics.
A development called inverse shoulder replacement now allows patients over
the age of 70 who have lost movement in their shoulders to swing their arms
to almost 180 degrees.
The operation is specifically targeted at the elderly because, while the new
shoulder replacement is adequate for the gentle activities of old age, it
may not sustain more vigorous youthful movements.
Angus Wallace, professor of ortho-paedic and accident surgery at the
University of Nottingham, said: “Thirty per cent of people over the age of
70 have torn rotator cuff tendons [a group of four muscles that are
positioned around the shoulder joint]. When these tears become very large,
people cannot lift their arms up to shoulder level so they cannot reach up
to shelves, they have pain in their shoulders and they find it difficult to
do the normal activities of daily living at home.”
William Bowers, a 79-year-old retired policeman from Nottingham, is now
enjoying his spring gardening after receiving one of the new shoulders.
Bowers, who has four children and eight grandchildren, said: “I couldn’t
lift my right arm, the one I depend on, more than 3in from my side.
Adjusting spectacles and washing all had to be done left handed. Gardening
was out of the question.
“I can now lift my arm to 170 degrees which is marvellous. I can do the
gardening again.”
Advances in the treatment of cancer, including better drugs and more efficient
use of chemotherapy in combination with radiotherapy and surgery, have
turned a fatal diagnosis into a manageable long-term condition for many
patients, doctors say.
Professor Karol Sikora, medical director of Cancer Partners UK, a private
cancer company, said: “We are converting cancer into a chronic controllable
condition. There are many people with breast cancer that has spread, and
prostate cancer that has spread, who will live another 20 years.
“The average age of a new cancer patient in Britain is 68 years. If we can
keep them going for 12 years then that gets them to 80, which is the average
age of death. What we are going to see is people with cancer and heart
disease living into the time when they would normally die of multiple causes
anyway.”
Life expectancy in Britain is now 77 for a newborn baby boy and 82 for a
woman. Sikora warns, however, that looking after these elderly people with
several illnesses is expensive. He says that we are also living to an
“unnatural age” because technology has defied nature.
“In the Stone Age men and women died in their thirties, once they had had children,
because they were not needed by evolution to carry on. Now health technology
wipes out evolution and we are into an unnatural stage. No one was meant to
live to this age,” Sikora said.
Perhaps the most conspicuous way medicine is tinkering with evolution is in
fertility treatments. Technical advances have allowed women in their sixties
to give birth. Patricia Rashbrook, a psychiatrist from East Sussex, gave
birth in July 2006 at the age of 62. Adriana Iliescu became the world’s
oldest mother when she gave birth after IVF aged 66 in 2005. Drugs for
erectile dysfunction, such as Viagra, are also allowing older couples to
lead active sex lives much longer than before.
IT is not all fun and good news, however. At the same time as medical advances
are extending life, the way we behave threatens to shorten it. The epidemic
of obesity is leading some experts to predict that the present generation
will die younger than their parents. One American study has already shown
that in isolated areas life expectancy has fallen because of overeating and
lack of exercise. Pills and surgery should not be seen as a solution to such
overindulgence, warn the experts.
Professor Janet Lord, chair-woman of the British Society for Research on
Ageing, said: “For the polypill, the data certainly bode well for improving
health in old age if [it is] taken early enough. There is also some evidence
that the use of statins may even be able to reverse the early stages of
conditions such as athero-sclerosis [clogging of the arteries]. But
directing our efforts to improve health in old age solely towards a
pharmacological intervention is unwise.
“Most of the effects achieved by the polypill could also be gained by
increased physical activity. There is a danger in people taking a polypill
in the belief that this will guarantee good health in old age and remove the
requirement to maintain a good lifestyle.”
That said, for those who do maintain a healthy lifestyle, medical advances
offer the opportunity to rebuild themselves in ways and at ages rarely
possible before. Barry Giles, a 71-year-old retired businessman from West
Sussex, was one of those who has refused to surrender to time. Although
losing teeth has long been associated with advancing years, he was having
none of it when he had his jaw rebuilt after a cancerous tumour was removed.
Giles became the first patient in the world to undergo a 15-hour operation to
rebuild his jaw with a replacement set of teeth implanted at the same time.
“About four weeks before the operation, I said to my surgeon: you are going
to take all my bottom teeth out, how am I going to eat? I told him I had
read an article about a dentist who can make special dental implants,” he
said.
“They put their heads together and worked like the clappers. When I woke up
after the operation, I had a full set of teeth. It was nice waking up to
think I was almost perfect.”
