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This information is from the New England Centenarian Study (NECS), a population based study, undertaken by the Department of Medicine, Boston University Medical Centre, Massacuhetts, USA (reference: Longevity health Sciences: Annals of The New York Academy of Sciences, Volume 1055, December 2005). Centenarians achieve their age by virtue of ageing slowly and significantly delaying or escaping the diseases associated with ageing. There are many definitions of what 'ageing slowly' might mean.
One popular definition is a decreased rate of decline of a adaptive capacity or functional reserve, and therefore a decreased vulnerability.
It would make sense, therefore, that a person who develops a stroke, heart attack, or Alzheimer's disease in his/her early 60s or 70s would be unlikely to be able to go on the extra 30 or 40 years to age 100.
Compression of disability: It used to be accepted that in those with prolonged longevity, the onset of age related diseases was delayed until the last few months of their lives. (Compression-of-morbidity hypothesis).
However, the data from the NECS now show that in the case of centenarians, a substantial proportion do not delay age related illnesses, but they appear to postpone disability to very advanced ages.
In this study it was observed that 90% of centenarians were independently functioning at the mean age of 92 years.
Further examination of the ages of onset for ten common age-associated diseases, namely, hypertension, heart disease, diabetes, stroke, non-skin and skin cancer, osteoporosis, thyroid condition, Parkinson's disease and cataract, among 424 centenarians, revealed that the centenarians fit into three morbidity profiles: 'survivors'; 'delayers', 'escapers'.
Survivors are individuals who were diagnosed with age related illness prior to age 80 years. (accounted for 24% male and 43% female centenarians)
Delayers, are individuals in whom the onset of age-related illness were delayed until at least 80 years. (accounted for 44% male and 42% female centenarians) Escapers, are individuals who reached the 100th year of life without the diagnosis of age related illness. (accounted for 32% male and 15% of female centenarians).
Typically 85% of centenarians are female and 15% are fewer in number, they were more fit than their female counterparts.
The reasons for this apparent paradox may be that, for unclear reasons, women are physiologically stronger than men when it comes to maladies associated with ageing.
Women thus carry a double edged sword of living longer with diseases associated with ageing rather than dying from them relative to men. It could be hypothesized that men, on the other hand, must be relatively disease-free in order to reach 100.
Apparent paradox
These results suggest there may be multiple routes to achieving exceptional longevity and that there are gender differences according to which route is taken.
The identification of these subtypes of centenarians, survivors, delayers and escapers, provides direction for future study into factors that determine exceptional longevity.
Thus, when data of the ongoing HealthWatch Centenarian Study, which is the first community based study in our country are available, would provide useful information relevant to us on factors that are associated with exceptional longevity.
Kandy SLDA organised low cost volunteer diabetes care unit:
A model for this region
THE Kandy branch of the Diabetes Association of Sri Lanka has organised a trained volunteers group to attend to Diabetic control needs in the community, which is becoming a low cost Diabetic control model for countries in this region.
This is revealed in an article sent to the HealthWatch by the Kandy branch of the SLDA to mark the World Diabetes Day November 14.
From Kandy branch of the SLDA
A low cost model for delivery of diabetes care
Diabetes is a chronic disease the complications of which could affect virtually any organ or system of the body.
The 40 year old mason who has sustained a heart attack, a 67 year old grandmother who has developed paralysis, a 20 year old university student who has lost his vision and the 52 year old farmer whose leg had to be amputated are all affected by this dreaded illness.
Some of these people being in the most productive years of their lives would even lose their livelihood with severe economic repercussions not only on their respective families but also the country in general.
The theme for this year is 'Diabetes in the disadvantaged and the vulnerable.' This theme has been selected to highlight that diabetes which was once considered to be a disease of the rich and the affluent could also affect the poor and the disadvantaged.
Since some parts of the world particularly in Asia and Africa are still considered to be poor, the effect of such a debilitating illness on the population could be devastating.
In fact diabetes has reached epidemic proportions in developing and poor countries such as Sri Lanka where the incidence is due to go up by nearly 70 per cent during the next 20 years.
At present it is thought that there are nearly one million people with diabetes in Sri Lanka.
It would be a challenge indeed for the State to manage such a large load of patients who need lifelong monitoring and treatment.
We are a relatively poor country the majority of whom are dependent on the State for maintenance of health and education.
When it comes to diabetes too, nearly 90 per cent of patients still obtain their treatment from Government hospitals which already are overburdened with lack of resources both human and financial.
Therefore, it is mandatory that suitable techniques and procedures are adopted to cut down on the cost of delivery of diabetic care.
With this objective in mind, the Diabetes Association of Sri Lanka (Kandy Branch) implemented an ambitious programme to train volunteers from the community to attend to some aspects of diabetes care.
Being volunteers rather than paid employees was considered to be a factor which would enhance their devotion.
Furthermore, since they were well known to the local community, it was thought that the advice provided by them would be well accepted. These volunteers were called Diabetes Support Workers (DSWs) and were selected following a written test.
They underwent training over a period of 6 months and the curriculum consisted of 6 modules which included both theory and practical classes.
A test was conducted at the end of the training and those who pass were recruited as DSWs. They were expected to perform the following functions.
1. Identification of undiagnosed patients
2. Advice on diet, drugs and foot care
3. Advising family members on prevention of diabetes
4. Organising community educational programmes
5. Advise mothers and pre-school children on proper diet and hygiene
At present there are 30 such DSWs performing their functions admirably well. They have been in operation during the past 5 years and the community that they serve has benefitted immensely by their services.
Undiagnosed patients
One of the most important functions performed by them is the identification of undiagnosed patients. These patients include those who do not know that they have the illness in spite of the presence of symptoms.
These patients are identified by the DSWs on suspicion and referred to hospitals where the proper diagnosis is made by a blood test.
These patients if remained undiagnosed would have ended up with some devastating complications mentioned above.
Awareness programmes
Some of the DSWs were able to organise community educational and awareness programmes usually held in a school or a temple and addressed by suitably qualified medical personnel.
These programmes are usually held on a Sunday or a Public Holiday so that even the Government employees and schoolchildren are able to attend.
Fast foods
The unhealthy practice of feeding our younger generation by so-called 'fast foods' too have been addressed very effectively by the DSWs who regularly advise parents who bring their children to pre-schools.
It is now thought that consumption of such unhealthy food is an important cause for diabetes and other chronic illnesses in the younger generation.
Insulin Bank
A more recent activity performed by the DSWs is the administration of the Insulin Bank established by the Association at Peradeniya.
A large number of patients from the Central, North Central and Sabaragamuwa Provinces collect their supply of insulin from this centre rather than to travel to Colombo incurring heavy expenditure.
As for the future, these DSWs will be further trained to perform such activities such as measuring the blood pressure, testing blood sugar by the glucometer and venepuncture to obtain samples of blood for important tests such as estimation of blood cholesterol.
It is also envisaged that such activities would be spread to the rest of the country and the Government provides some amount of recognition to these dedicated set of human beings who have come forward voluntarily to care for their fellow human beings so that the illness and its complications of this dreaded disease are recognised early and adequately treated.
The authors also feel that this is a low cost model for the delivery of diabetes care to other developing countries in the region.
Sports injuries
TODAY sports medicine has become a speciality. Sports have become extremely popular in the modern world. This is a guide for the eye care needs of the participants.
In Sri Lanka today the most important sports are mentioned below:
1. Cricket
2. Racquet sports
3. Baseball and softball
4. Volleyball
5. Football
6. Cycling
7. Swimming
8. Soccer
9. Running and jogging
10. Boxing
11. Wrestling
12. Fishing
13. Rugger
Cricket
This is responsible to ruptured globe, corneal abrasions, lid lacerations, hyphaema and retinal detachment. These could be prevented or reduced by wearing special protectors.
Racquet sports
This is a common cause of serious eye injury like hyphaema. Badminton and squash increases risk of injury.
Since many racquet sports players wear ordinary spectacles, eye injury can be caused by shattered spectacle lens. These can be prevented by wearing sports goggles with polycarbonate lenses.
Baseball and softball
Though the risk of eye injury is less, no one really uses any protector. If injury takes place from a ball impact to the head the batter especially should wear a polycarbonate face guard on helmet.
Volleyball
This again could cause eye injuries like subconjunctival haemorrhage and corneal abrasions. Normally no protector is recommended.
Football
Superficial injuries are common.
Cycling
Injuries to the head and face are the leading causes of cycling injuries. Crashes and falls can cause optic neuritis.
The universal use of helmets should be advised to all motorcyclists. Many cyclists complain of constant gritty eye irritation from wind and sun exposure.
A lubricating drop gives temporary relief but a good wear of polycarbonate lenses protects the eyes from dust, dirt, wind and ultra violet light.
Swimming
Eye injuries are uncommon and are usually caused by finger pokes. The swim goggles can cause injury to the eye if it is not properly fitted. Swimming pools are sometimes contaminated with coliform bacteria which can cause infection.
Soccer
Injuries like hyphaema, corneal abrasion, contusion, angle recession and vitreous haemorrhage could take place.
Running and jogging
Eye injuries result from striking branches of trees, twigs and pipes. These do not cause a greater incidence of retinal detachment.
Some glaucoma patients could have intraocular pressure raised after strenuous exercise. This could be prevented by the use of 1/2 per cent pilocarpine 1/2 hour before physical exertion.
Boxing
Significant eye injuries like retinal detachment, angle recession, macular scarring and cataracts. Head gear had become compulsory in olympic boxing.
Wrestling
Usually the eye injuries are relatively mild like corneal abrasion and lacerated eye brows.
Fishing
Ultra violet light and irritation occur in this outdoor sport. Fishing injuries from hooks will lead to removal of the eye ball. Spectacles with polycarbonate lenses in the form of sunglasses or corrective lenses should be worn.
Rugger
Eye injuries can occur due to falls and knocking into each other.
The majority of sports eye injuries are preventable if a specifically chosen protective system is adhered to.
In prevention the ophthalmologists have a small part to play. You should know the patients potential for eye injury, should give special prescriptions for protective devices.
The lens material of choice for piano and prescription eye wear for normal wear and protection is polycarbonate.
These lenses have high impact resistance, good optical qualities, efficient ultra violet absorption and scratch resistance coatings are safer than glass or CR39 plastic lenses. Lenses for special applications such as welding and exposure to high heat should be recommended.
For those sportsmen with a high range of refractive error should not wear lenses made of polycarbonate.
They should be recommended contact lenses which should be protected by sports goggles with polycarbonate. Most eye injuries could be prevented if they wear protective devices.
Ophthalmologists should take a history from the patient who may be exposed to potential eye injuries and writing a prescription for the necessary protective wear. In addition that patient should be given educational materials if available in the consulting room.
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