GH3 - GEROVITAL Articles (XI)

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DR. DUMITRU'S INTRODUCTION

"Quality of life (Q. of L.) is the contemporary goal of Gerontology. Until now, this concept (Q. of L.) seems to form a Gordian knot that nobody is prepared to untie at the present time period. My opinion is to use a Global Vision to recognize individual and cultural variations.

A global vision conceptualizes Q. of L. as a ontogenetic process that is produced by a complex of individual, social and environmental factors.

In this vision the individual is the cornerstone and is directly influenced by many factors. Each factor can be changed throughout life.

This dynamic vision may be used to clarify the complex relationship between positive, negative, subjective and objective indicators, and in each case to take practical measures to enhance the Q. of L.

I believe that in the next century, Western high tech and Eastern ancient art and medicine will merge to create a holistic health care in order to promote the Q. of L.

Aslan's 10 commandments synthesize the importance of general and particular recommendations to delay the aging process and to maintain a healthy and active body."

ASLAN's TEN COMMANDMENTS
By Mircea Dumitru, M.D., Ph.D.

Professor Aslan proved that it is possible to fight aging. Everything she thought of, and carried out was like declaring war on old age. Her war was equivalent to those against cancer and smoking. Her wish to find the most adequate way of fighting made her affirm many times that "old age is a parasite of life."

Initially, the firm, prophetic convictions and attitude she adopted made some gerontologists regard her attempts with skepticism. Their distrust was motivated by the complex determinism of aging and by the insufficiency of some biological arguments. However, time has rendered more justice. In hundreds of laboratories, scientists are now concerned by new theories on the way people grow old. They are trying to find out the secret of youth and the mysteries of longevity. In the near future it will be the possible to double, or even triple the life span of the human being.

The first time Aslan introduced her concept of Gerontoprophylaxis was at the International Conference of Gerontology in1956, at Merano, Italy. This synthesized the importance of her treatment and included general recommendations to delay aging and maintain a healthy and active body. Since then, health literature and the mass media have saturated the public with such advice. Let me tell you about what Aslan named "Decalogue", which after some time I referred to as "Aslan's Ten Commandments".

1 Food-A Secret to an Extended Life;
2 Physical Movement;
3 Training for Aging.
4 The critical age (40-65 years).
5 The art and force to experience positive emotions.
6 To prevent chronic diseases and to learn to live with them.
7 Pregeriatric and Geriatric examination.
8 Longevity-family and sanogenesis.
9 The Elderly's Leisure.
10 The Drugs of Intelligence and Gerovital-H3®.
11 FOOD-A SECRET TO AN EXTENDED LIFE

It is said of the appetite what "Leonard da Vinci" affirmed about painting: "Es una cosa mentale" [it is a mental cause].

In French culture there are many references on the noxious role of abundant meals, being mentioned that "lunch kills half of mankind, and dinner the other half."

Centuries ago, it was noticed that a diet reduced in calories and rich in vegetables and fruits represented an important factor of longevity. Meals eaten together with beloved persons maintain physical tonus and delay aging.

Research workers in gerontology identified "Isles of longevity", and connected this fact with nourishment rich in milk products and fish. Some of them even affirm that "Numerous biological sings of aging are valid only if they are considered markers of nourishment, of inactivity". They are inclined to answer affirmatively to the question, if the genes which protect youth are possibly influenced by what we eat. Food provides not only proteins and energy, they also have an important role in genes and good functioning which influences longevity. It has been discussed, and an effort has been made to isolate certain revitalized nourishment principles, more efficient than vitamins, which are found in lemons, garlic and liquorice root.

If, in the past decades chronic diseases were considered as a prerogative of advanced age, in the last few years they are more and more related to nourishment type, personal habits, and inadequate mental stereotype. There are known food stuffs with a strong anticancerous effect, and there are prospects to isolate these food principles with a rejuvenating effect, and which are found in infinitesimal quantities in common nourishment. The basic compounds of sulfur present in garlic prevent esophageal, colon, and rectal cancer, and strengthen the liver detoxification function. By these results, indirectly, we extend the life span, knowing that the tumor incidence increases with the advancing age. Food fortifying by natural protective products is an interesting and important way to prolong the life span. In food stuffs there are chemical compounds with antioxidative qualities, which neutralize the free radicals, and which appear when the cells use oxygen to generate energy.

In Latin America, Asia, there are groups of the population without colon, or breast cancer. They eat fresh vegetables and fruits, wheat, whole meal, and milk products.

The most important nourishment benefit for good health proved to be food reduced in fats. After such a diet, the vascular cerebral, and coronary diseases decreased up to 40-45%.

Everyday the human body needs a certain quantity of vitamin "E, B1, B6, A, D, Zinc, Iron, Folic Acid, Calcium", for certain specific functions and optimum functioning of the immune system.

In elderly people we should take into consideration the fact that they eat less, are sedentary persons, and maybe ill, (possibly taking drugs), factors which may interfere with the absorption in essential food principles. In this conditions, additional quantities of nutritive factors are required.

IT IS A SCIENCE AND AN ART TO EAT ADEQUATELY, SO THAT IN THE LATER YEARS, YOU WILL BE ACTIVE AND HEALTHY.

The secret consists of a diet rich in essential food principles, and with a lower number of calories. An adequate nourishment supposes quality, rhythm, a certain value, all are attributes designed to prevent diseases frequently met in the elderly: diseases such as; diabetes, obesity, arteriosclerosis, arterial hypertension, poliartritis, food, and vitamin deficiency.

Among the elderly's disturbances of nourishment related to food quantity and quality, I note the following nutrition, and mal nutrition. DENUTRITION of the elderly has a multiple causality. At this age we meet denutrition states by:

Diets which some elderly people establish themselves (preconceived ideas, occult influences, habits in family);
Negligence following an insufficient care of the teeth in childhood, or maturity;
Denutrited by conviction due to some psycho-somatic sufferings. (Elderly people observe a severe diet on their own initiative, (because of stomach, intestines, liver, or kidneys);
In the complex diet of nourishment, the social factor has an important prevalence, so that it is not astonishing that there are also so-called solitary denutrited persons, relatively frequently met in the conditions of an increased life span.
Loneliness is associated with depression and a low interest in cooking food which are elements which generate a lack of appetite.

If a common cold occurs, a trauma, a cardiovascular suffering, "Syndrome of sliding," a lack of appetite occurs immediately. The rapid and severe degradation of the elderly's general conditions appears first caused by poor appetite, and then by the disease itself.

MALNUTRITION is determined by a deficient food balance. The energetic requirements should be individualized according to sex, nutrition state and degree of activity. After the age of 50, it is recommended to reduce caloric supply by 7-10% every ten years.

After the age of 65, it is necessary to have an average of 2200 calories in 24 hours, but for those with obesity it is recommended an energetic supply not surpassing 1800 calories in 24 hours.

Proteins, specially those of animal origin, in quantities of 1-1.5 g/kg. (1kg = 2.2pounds) body-weight/24h., are essential in the period of growth and in old age. The minimum is of 100g/24h., and for weak people, or after surgical interventions, when the supply may reach to 150-200g. proteins in 24hr.
Those who have lost their teeth should eat finely cut meat. Fowl is indicated, a quantity of 150g providing 25.6g. proteins.
Fish, 150-200g in 24 hr., as well as fresh eggs, 1-2 a day, twice a week may replace meet. Milk, and milk products are useful (a jar of yogurt contains 4.2g. proteins), but for an older person it is not recommended a strictly milky nourishment.
Rice, semolina, pastes, bread provide 50% of the necessary proteins. Dry vegetables, which are difficult to digest as well as fat, salty, smoked sausages should be avoided.
A diet low in protein (25-30g/24h.) is indicated in renal diseases. The hyperproteic diets (200g/24h.) is recommended for states of denutrition.

The needs for Lipids (fats) for the old man raise to 40-50g/24h., and they are obtained from: lean meat and butter, 10-15g; oil-20g., milk and cheeses 25g.
The obsession with an increased cholesterol of dislipidemias is not justified after the age of 70 years old.
The critical period is situated in the decade 5 and 6 (40-60 years of age). The suffering which appears after the age of 70 is the result of dietetically errors accumulated during the life time.

The ratio of Carbohydrates (including sweets) should not surpass 50% of the total calories in 24 hours, so that 150g. bread, or 200g. potatoes, or 150g. pastas, 100g. rice, 250g. grapes are enough. It is advisable to avoid confectionery such as cakes, or candy.

The hydride supply, as well as mineral salts is indispensable. In a 24 hours period one should drink at list 1 liter of water, to which should be added soup, tea, coffee and a little wine. In the evening it is better to avoid ingestion of liquids because the need to urinate causes insomnia. The infusion of lime-blossom, thyme are useful due to their physiotherapeutic qualities.

In osteoporosis it is recommended to undertake a nourishment rich in calcium (milk, cheese, eggs) which represented in a minimum of 800 mg/dairy produce.

A glass of milk contains 0.295g. calcium, and 8g. lipids.

Magnesium has an important role for the elderly, the minimum need being 6mg/daily. It is found specially in uncooked vegetables.

Spinach, stinging nettle, liver, apricots and lentils contain the iron element, and should not be removed from the elderly's diet. A daily supply of 12-15mg is necessary (100g. of liver contain 11.3mg. iron).

In regard to mineral salts supply, I should emphasize the role played by sodium and potassium. Sodium is very necessary for the elderly; a sodium free diet causes inappetence, even neuropsychical disturbances. The diet free of salt is recommended for a short period of time only, and it has special indications, such as when hypertension onsets, or a period of acuteness in cardiac failure. In 24h., 3g of sodium is necessary (1 liter of milk = 1.5g of sodium).

The potassium need is 3-4g. daily. Here are some examples of vegetables and fruits rich in potassium (the content is calculated/ 100g).

Dry apricots = 1600mg.
Carrots = 300mg.
Dry plums = 950mg.
Figs = 983mg.
Oranges =187mg.
Bananas = 300mg.

FOR PEOPLE FOLLOWING A TREATMENT WITH DIURETICS A SUPPLEMENT OF POTASSIUM IS RECOMMENDED.

Fruit juices complete the need of vitamins.

The elderly menu should be varied and individualized. The rich and unique meals should be avoided. Four meals a day are desirable. Breakfast and a snack in the afternoon are important for the psycho-physiological point of view. Selective and restrictive diets should be avoided.

Following a nourishment program on a group of elderly persons, I noticed: among those over 85-90 years of age that 56% had a mixed diet, 27% ingested predominantly milk products, vegetables and fruits, and 17% ate mainly meat.

I discovered that the mixed diet is prevalent in longevous people who live in rural areas. I also noticed a decrease of pork intake with advancing age. In exchange, fish intake was increased. What should be emphasized is the elimination of culinary refinement; boiling was the prefaced way of preparation and fresh green vegetables have been used also.

The intake of alcoholic drinks in both sexes was more in the rural areas. The percentage of longevous people who have not regularly ingested alcoholic drinks were men in urban areas 60.2%, and in rural areas 47.9%; in women the rate is respectively 82% and 73%.

It is an aspect not without importance: the alcoholic drinks used by the elderly, especially those living in rural areas were prepared on their own farms, and had a reduced content of alcohol.

The nourishment peculiarities of longevous people show the habits of the last 90-100 years. In the last two three decades, in parallel with the general change that occurred in people's life, there were also changed in their diet habits.

Since the years of the "60's", "70's" and "80's", especially in the developed countries, a hypercaloric food prevailed due to the increased intake, more over, the organisms energetic need for fats and sweets. The hypercaloric food predominantly glucidic and lipidic, generates metabolic lack of balance, and increases the frequency of chronic degenerative diseases.

The care we take for a nourishing diet is determined by preventing metabolic lack of balance, and represents a first rank security for the maintenance of a healthy condition over the age of 70 and 80's.

Recommendations for preparing the foodstuff

By a correct preparation of foodstuff the entire nutritive value is guaranteed, and the possibility for them to become toxic is avoided. At 65°C the proteins begin to coagulate, and at 100°C they change into soluble substances (a process similar to digestion). Through boiling the purinic bases pass into water, and give taste to soup, and in the body change to uric acid.

Boiling is still the best way to prepare meat, as long as the meat is not inserted until the water has reach the boiling point, a proceeding by which the extractive substances remain in the meat.

It is recommended for the elderly to eat only boiled meat, baked, or grilled under a lid. The meat when it is prepared in the oven should be covered first in a sheet of parchment which absorbs the grease and prevents the formation of a crust.

Elderly people are forbidden to eat roasted flour, this being replaced by a browning without grease, in the dry stewpot after which is added vegetable soup or meat soup.

You do not add oil and butter until this mixture is boiling. The taste of roasted flour is similar to roasting, and in addition it has many advantages.

The SCIENCE and ART to NOURISH ourselves, by balance, moderation, and knowledge of the secrets of preparation, plays a major role in giving YEARS to LIFE and LIFE to YEARS, in the conditions of the elimination of physical and emotional sufferings. With a good nourishment and Aslan's treatment, you will maintain your vitality and a normal rhythm of aging.

To lose weight you have to reduce your consumption of high-fat, high-calorie foods and increase physical activity. You must to personalize your plan to fit your own needs.

TRAINING FOR AGING

Research about the lifestyles of long-lived people reveals that good physical, psychological, and social condition depends on certain behavior. In fact, the behavior conducive to a long, healthy life, which leads to an active and dignified old age, begins in early childhood. This optimum lifestyle decisively influences health in later life. Training for aging should be started in the first years of life, as any disease or bad habits may adversely affect the aging rate. Delayed psycho-motor development, or a glandular imbalance, should encourage parents to make an in-depth check-up of their children.

In the first part of life, preventive measures are the responsibility of the parents. Afterwards, adolescents and young people should themselves be conscious of the late consequences of diseases, of the deviations from a balanced way of life and of harmful influences of the environment. From this point of view, we should know that healthy aging is affected not only by genetic factors, but also by environmental factors: climate, air purity and geographical conditions.

Aging is highly individualized. Training for long life depends mostly on the social and cultural level of the group to which we belong. The way we live our lives is learned first in the family, and later in school and society. I emphasize all these because habits are hard to change especially in old people. We can make things worse when we try to change some habits which have lasted for more than 20 years. For example, many of us know how difficult it is to give up coffee or tobacco. (Ed. My father said it was easy, he did it twelve times!)

Parents shouldn't be concerned about obesity in children until they are at least 2 years of age. Putting an infant on a diet at this age is more harmful than good. After that time, children in families with a history of cardiovascular disease, who have increased levels of blood lipids should be evaluated. Overweight children whose cholesterol is over 180 mg % should be placed on a diet. During childhood and adolescence, the child should be encouraged to participate in vigorous physical activity. A high level of physical activity and lower levels of cholesterol in the first part of life will have a tremendously beneficially effect on later health. The child should also acquire good eating habits. Discipline in school, exercise, and learning of foreign languages, are all helpful to form strong characters and healthy habits.

Whenever preventive gerontologic examinations are performed, the physician individualizes advice according to the GERIATRIC CODE: to maintain health, an optimum balance should have between work and recreation, and a profession should be pursued which gives one satisfaction. A person who has more than one profession has an advantage over a person who concentrates on only one.

The lifestyle most likely to result in good health and long life is one which minimizes the stress of our high-tech, bad environment, actively uses leisure, avoids toxins, maintains a high level of intellectual and physical activity and a balanced diet. These factors have a major role in training for old age an extending the active life span.

"PEOPLE WHO ARE PHYSICALLY AND INTELLECTUALLY ACTIVE HAVE NO TIME TO GROW OLD".

Work is a fundamental requirement of human life. Its beneficial effect on body functions and the major role it has in maintaining physical and mental health are well known. Throughout the entire cycle of life, starting with the period of education and learning, continuing into the period of maturity and productive contributions to society - man participates in a permanent process of working and self-fulfillment.

In training for aging, the time of retirement is a milestone. The "third age" corresponds to the period when this permanent activity ceases, and there is a change in the occupational and social status. At present, the social age of retirement has a tendency to increase, and the concerns related to this period have not been missed from the sociological, economic and psychological investigations.

At a meeting in Vienna in 1982, the concept of "active elderly" was promoted. This concept proposed that training for retirement has to be incorporated within the complex program of training for aging, an evident option for employing the elderly in accordance with their level of education, functional capacity, and the struggle of the elderly themselves for a new status and social role.

Retirement is an important moment in an individual's life and it is differently regarded - not only according to the type of retirement (i.e., due to age or illness), but also to many other factors: temperament, sex, and previous extra-professional concerns. For those who are unprepared, retirement may represent a major stress, causing a real moral crisis - "crisis of retirement", "drama of retirement", or, as the German authors call it, "Pensionkrankheit" (pension sickness). The crisis of retirement is evident most frequently in those who had no previous hobbies to occupy their time.

Until a certain point, it is natural for us to think that the human being develops under the influence of labor, which formed his/ her personality and character, which imposed rigor, order and rhythm. Retirement disturbs this human necessity, and breaks this natural link which severely upsets the somato - physical balance. If "pre-retirement" training has not been accomplished, retirement brings about inertness, lack of initiative, loss of social relationships, and increases the tendency to physical and psychical immobility. There is an increased preoccupation about health, resulting in anxiety, depression, ending in isolation and solitude.

The maintenance of intellectual aptitudes and creativity, a certain spiritual rejuvenation by the association of wisdom, experience and a wish to be useful - even if the passing of years were merciless - are part of the remedy for the "retiring disease" and aging.

Another aspect of great importance after the age of 65 is represented by "The Elderly's Leisure", which should be understood in accordance with the major needs of this age. If good health is maintained, the elderly may remain socially active. The elderly like to be recognized as individuals, and to express their personalities. Far from being only consumers, the elderly may participate in many activities within the limits of their functional capacities. Creativity is frequently present in the advanced ages to a surprisingly high degree, and lasting pieces of work are often produced during these years. At this age, as a result of their relativity long life and experience in all fields (arts, literature, philosophy, music etc.), history knows of personalities which otherwise nobody would have heard about. In human, ethical and moral terms, the elderly represent a treasure of wisdom and history, and may be of great use for society and family. By their presence, we all are much more wealthy.

Education is another indicator of old people experience. The elderly can tell us how we reached our present standard of civilization, because they were witnesses and creators of past events. Therefore, the time of aging belongs not only to the elderly, but also to society, to all of us. If they do not have a second occupation or a hobby once they have reached the age of retirement, some old people only then realize that they have no choices.

Geriatric physicians have a duty to "sound the alarm bell" and to train the population, (beginning in youth), about what they should do after retirement. Elderly people need an occupation, above all, to maintain their physical health. Labor represents a basic requirement of human existence, and in this respect, an experiment performed in Montreal by Prof. Hebb is very interesting. He looked for and found volunteers for...laziness! In addition to paying them, he provided them with comfortable accommodations. From the 46 persons selected for the study, only one was willing to not work for more than 5 days, one for 117 hours, another for 114 hours, and the others gave up after only 70 hours.

Work has also been used as a treatment for some diseases, so called occupational therapy. The Greeks and the Egyptians practiced occupational therapy for mental disturbances. "Philippe Pinnel", even in 1909, found out that labor rigorously carried out represented the best way to maintain the health and high spirits of retirees in a home. The wish for activity is also experienced in advanced ages. Prohlic, in his paper "How should the retired organize their life?", shows us that the elderly, like the young, are in need of affection, the freedom to choose their friends and to be useful in the community.

Leisure is known by different names: "loisir" in France, "leisure" in England, "non-working time" or "free time" in the United States, "Freizeit" in German. In ancient times, the Greek word for "school" had multiple meanings, i.e.: repose, leisure, lack of activity, occupation during the free hours - after work, or after business, study, conversation. School also meant the place where this time was spent. Leisure activity should be outside all basic obligations, and have no utilitarian purpose. We should seek satisfaction, relaxation, entertainment, or education. Leisure should be a time of absolute individual liberty. Unlike the adult's leisure, the elderly's leisure should be a continuous time of doing as they wish.

Cessation of many formerly pleasurable social and professional activities after retirement often produces a great deal of anxiety. In order to compensate for the loss of socio-cultural, socio-economical or political activities and responsibilities, I recommended the following activities substitutes:

Physical exercise and sports, to include any sport which can be practiced age, by the elderly who are in good health.
Cultural activities like music, painting, writing, reading, scientific work, studying foreign languages.
Useful activities like handicraft/ repairs, gardening (more than 40% of the people over 60 are involved with gardening). People should train for the onset of old age. It is both an art and a science to become a successful old person.
Victor Hugo wrote a volume of poetry titled "The art of being a Grandparent". An American author wrote, "Life Begins at 40." Michelangelo began to learn Greek at the age of 80. Margaret Murray wrote "My First 100 Years." Cicero, Seneca, Shopenhauer, meditated upon age, and training for old age.

Let's plan and train with wisdom (attributes of aging itself) for a long healthy life!

PHYSICAL MOVEMENT

In the context of the present decade, the third age (people over 65) is considered as the period of life in which experience, knowledge, capacity of creation can, and should be fully used.

An active elderly person does not grow old intellectually, physically, socially and he has no time to think of aging.
Sedentary life (physically giving up), and isolation are major risk factors in the acceleration of somatic, and social aging.

Physical exercise should not be missing from the life of a person. It maintains a satisfactory condition of cardiovascular functional parameters and of osteoarticular system, creates a physical balance and generates a tonic feeling of independence and usefulness.

The antithesis, the sedentary life, lack of physical movement, to which overfeeding is added, and some other factors, favors the appearance of atherosclerosis, arterial hypertension, and chronic degenerative rheumatism.
Until the age of 40-45, constant physical activity maintains a cardiovascular performance, and prevents the appearance of chronic degenerative diseases.
Between the age of 45-65, the daily practice of physical activity is necessary, but the physician's examination decides the degree and nature of this activity.
It has been scientifically proved that exercises favor longevity.
The higher indexes of morbidity and mortality by coronary diseases are met in those who do not exercise, and those who only "change armchairs".
Walking and physical movement generally stimulates the mind.

Philosophical thinking gained much after the discussion between Plato and his disciples in the alleys of the Academous garden.
The great thinkers, Göethe, Rousseau, Cicero, Plinius the Old, talk about the beneficial affects of walking in the open air. Walking is disconnecting, it generates ideas, and gives solutions to problems still unsettled.

Physical activity plays a great role in maintaining body weight, physical movement being the simplest and physiological means of control an decreases the excess of body weight.
By the burning of 100 calories correspond to daily climbing stairs of 15 minutes, or an interval of 20 minutes running, or 15 minutes cycling. The loss of 5-6 kg could be reached in a year.
There are people who abstain or limit their physical movement for fear of an increased appetite. It is a false opinion and it can be affirmed, that sedentary people have an increased appetite.

At the age of 65, we could be as strong as at the age of 35, and at the age of 75 to have the same physical health as at the age of 50. By physical movement the muscle is strengthened and developed, which after the age of 40 diminishes in volume, and is replaced by fat, the tolerance to glucose increases and arterial blood pressure decreases.
Simple physical exercise may stop the loss of bone mass both in the elderly, and in the women in the post - menopause period.
After a year of physical exercise (30 minutes, five times a week) may stop the decreasing density at the neck level of the femur, and vertebral column.

The immune system has positive changes in the course of the physical exercise program. Those who follow regularly this program, acquire a higher resistance to infections, and to the probability of having cancer.
It was also noticed that those who practice regularly physical exercises improve their way of life. They give up smoking and improve their diet.

The program of physical exercises is individualized by the physician according to age, and to the associated diseases.
Fever is the only situation which contraindicates the physical exercise because of the complications it may induce.

In order to have success it is advisable to observe the following conditions:

A program of physical exercise should be recommended by the doctor: he also establishes the length of time;
The person should use adequate equipment and choose the place of performance;
The dynamic movements are useful, those that involve simultaneously several muscular groups, apparatus and systems. Rhythmical movement is recommended, in fresh air, with deep breathing, at regular intervals.
Physical exercise "on the spot", requiring great effort (heavy weight lifting, fast running on short distances)- is not recommended. To this effect, old age physical exercises programs have been conceived, but there is still a lot to be done in this sense for determining the most suitable type of exercises and their effect, etc. Mandatory is that the exercises should be adapted to the individual functional capacity of the body and should be pleasant for the one practicing them.
Besides its sanoenergetic value, physical exercise is one of the really important factors in the therapy of nervous system diseases, cardiovascular, breathing and locomotor apparatus diseases. It is a well known fact that it influences the oxygen consumption at the myocard level, it contributes to developing the anastomotic circulation and the coronary territorial suppleness circulation.
In my medical practice, I recommended to my old patients with ischemic cardiopathy that they should take daily walks depending on tolerance, which means that the effort intensity shall be individualized and dosed in such a way as there should be no sensation of thoracic discomfort. In the osteoarticular apparatus diseases there should be medical physical exercises practiced in an individualized manner depending on the type and location of the degenerating process. There are exercises destined for toning up the hypotrophic muscular groups, and on the contrary there are exercises with an exciting motor effect.

Physical exercises has gained interest throughout the world due to its positive results, recorded both at the old patients with a satisfactory health status, and at the old patients with various chronic diseases. Systematically practiced and depending on everyone's functional capacity, it maintains the health status and delays the aging process.

THE CRITICAL AGE (40-65 YEARS)

It is the age at which everyone of us should take time to care of health for the following reasons:

In this period of time the biochemical and clinical signs of chronic degenerative diseases develops: arteriosclerosis, diabetes, arthritis, arterial hypertension, obesity and other diseases of nutrition and metabolism;
In women, after the age of 45-50 the menopause sets up, which means the ceasing of menstrual cycle. It is the moment when the ovaries start producing less estrogen and progesterone hormones;
In men, near the end of this period, and in women after about 5 years from ceasing of the menstrual cycle, osteoporosis starts to become evident;
Cholesterol is a general and major concern for good health. After the age of 40, in men, it has an evident tendency to increase. After menopause, it is very probable that the cholesterol level will increase and produce changes in the coronary, cerebral, renal and peripheral vessels. The higher the cholesterol values are, the greater is the risk to have vascular diseases.
And this is because in time, the cholesterol and the other fats in the blood (triglycerides, neutral lipids) are deposited on the walls of arteries and prevent the blood from reaching the important /vital organs. It is estimated that half of the United States adult population has a high level of cholesterol and other fats.
If the total level of blood cholesterol decrease by 1%, the possibility to die of ischemical cardiopathy, or to have "heart attack decreases by 2%". The normal value of cholesterol is allowed to be under 200 mg %. The values of 200-240 mg % are alarm values and the respective person should take some measures. The values over 240-250 mg % are high values presenting a risk for health condition. If to the cholesterol there are added hypertension, stress and increased body weight, the risk is even higher. The adult men present ischemical cardiopathy 3-4 times more than women. A man with high values of cholesterol, plus other risk factors, is considered to have an increased risk state, while women need to have a increased cholesterol plus at least 2 other risk factors.

In this way, the age from 40-65 is equally a critical age, both for men and for women.

The menopause in women, and the chronic degenerative diseases may generate change /modifications of sexual organs, frigidity, impotence, and disturbances of sexual dynamics.

The chronic diseases can be prevented and eliminated if they are revealed out in their preclinical stage, and they can be alleviated or cured if the first symptoms of disease occurred.

Pregeriatrics, a component of Geriatrics deals with the maintenance of health, diagnosis, and treatment of diseases which accelerate the aging process within the 40-65 age group. The yearly "check-up" represents the key to good health and delays the occurrence of the aging phenomena and helps to maintain an active life .

On the occasion of prophylactic gerontological examination there are established:

The biological age (personal research allowed me to elaborate a such formula;
The diagnosis of health;
The clinical and paraclinical diagnosis of possible disease state;
The recommendations and treatment are individualized according to clinical and biological pecurialities of each patient.
The geriatrician can use: geriatric treatments, anti-stress therapy, the therapy of pain and sexual disturbances, individual methods of physical therapy. Among the geriatric treatments, Aslan's method and Aslan's products are widely known.

The physician together with patient, will make an accurate plan to identify and reduce the personal risk factors.

The plan will have to include three main elements:

Changing of the life-style, in the sense of healthy conduct;
A balanced diet in alimentary principles (proteins, carbohydrates, fats, vitamins, mineral, salts), and with reduced content of calories 1500-2000 cal./24 h.;
An individual program of physical exercises and the proper use of leisure time.
The food is essential in this program. This change means unsaturated fats, a satisfactory intake of food reach in soluble fibers and a reduced number of calories till and optimal body weight is obtained. An example: for lunch, first dish should be salad with a dietetic-dressing and an addition of lemon. You should reduce the food quantity in your plate for the second dish, and finish the meal with an apple. ( "An apple a day keeps the doctor away). You should always leave the table without having the feeling of satiation.

In order to reduce the cholesterol and saturated fats, I recommend fowl without skin, or fish, a reduced quantity of vegetable oil (olive oil-1 spoonful=15 gr.), milk with 1% fats and cheese with less than 5 gr. fat/oz. Instead of butter, choose margarine made with unsaturated oils and avoid brains, liver and kidneys. Choose the food products to fit your health requirements.

One of the secrets of an active life without diseases is to make the Pregeriatric examination apart of your life.

The formation of a positive attitude is also very important at this age and it is not something you were born with.

It is a habit you acquire and you learn it within the gerontologic examination from the period of critical age. The things apparently insignificant should not be let to accumulate and endanger the life.

The critical age is the time of professional affirmation and the confrontation with many risk factors, of metabolic and physiologic changes, when once known, may be influenced in the sense of good health. At the same time it is the moment of acquiring some healthy habits: nervous hunger control, physical movement and maintaining a positive attitude towards negative emotions.

THE ART AND FORCE TO EXPERIENCE POSITIVE EMOTIONS

Love, generosity, abnegation, devotion, tolerance, forgiveness, optimism, hope, are experiences which strengthen psychically and reinforce the body. The positive feelings, security and conviction to control the situations to which you are faced belong to type of "A" behavior, to which belong most of the peoples of success.

Life dedicated to charitable deeds, means a lot of beneficial feelings which purify the soul. Life is in fact very seldom strewn with moments of happiness.

We go to be absorbed in the avalanche of news telecast: we wake up in a hurry and travel clumsily on the highways; the prices increases, the postman generally give us sad news: overcrowding, violence, incertitude, and problems at the workplace. Not only this, but also many positive experiences may be potentially negative: a promotion in the workplace may reveal a lack in training, which under other conditions were latent and not noticed; birth of much expected child, but who ends having a congenital malformation; leaving on holidays where you may have a serious accident; marriage may end in a divorce, etc.

These are some aspects of reality in everyday life of us. Among all, the existential negative experiences have the most evil implication on the health condition. The negative emotions, especially anger, fear, fright may lead to a sudden death. The negative emotions is the dark night who invites the diseases to start their fight against a weak organism.

Emotion itself is not harmful for the body, but reaction to this new situation may have a most harmful effect. The power to anticipate, or to be prepared and to react properly, make the negative consequences of a low intensity, or even harmless.

The elimination of pessimistic language, the friendly hand you give searching the good in what it is apparently bad, the virtue to forgive and forget and endeavor to replace the negative emotion with a positive one outline the art of living creatively . Learn and practice HUMOR!

People who have humor live longer!

TO PREVENT CHRONIC DISEASES AND TO LEARN TO LIVE WITH THEM

The years of 60's brought us the concept of "Risk Factors" which make us approach with an understanding of causes, and mechanism that produce chronic diseases and opens important ways for the prevention.

It was noticed a direct relation between the level of arterial blood pressure, body lipids (specially cholesterol and triglycerides), smoking body-weight in excess, stress, alcohol intake and presence of chronic degenerative diseases.

The Framingham Study, and the researches which followed it proved to us that it is in our power to prevent, and to alleviate this diseases. In the United States a war was declared on some risk factors (smoking), and cardiovascular diseases registered a spectacular decrease.

With the advancing age, the incidence of these diseases increases. In addition, the age plays and important role in evaluation of hemodynamic parameters (arterial pressure), and biochemical state. The Arterial Pressure should be permanently controlled.

With age, in 80 % of population, the arterial blood pressure increases due to the loss of vascular elasticity. The decrease of arterial blood pressure can explains dizziness, falling, insomnia, anxiety at night and the state of confusion in the elderly. Many times the arterial hypertension can be a side effect of treatment with other drugs.

The increased pressure in the circulating system induces arteriosclerosis makes the heart increases the volume and to get tired, and insidiously the nervous system and kidneys are assailed. About 15 years pass until the appearance of ocular, nervous, cardiac and renal complications.

The most espoused people to make hypertension are those who eat much and with salt, who are nervous, older, who have parents or family members with hypertension, who smoke and drink alcohol, or use anticonceptives. The cardiovascular risk increases if the systolic pressure goes above 130 mmHg and the diastolic above 85 mmHg.

In people over 65 years, with normal aging, values of 140-150 mmHg are normal for systolic pressure and 80-85 mmHg for diastolic one. Each old person feels well with his own values of arterial blood pressure. In absence of arteriosclerosis, of some sign of cardiac, cerebral, or renal suffering and of other risk factors, the geriatrician should appreciate with much discernment the utility of decreasing at this age the limit values of the arterial blood pressure.

At the present time the arterial blood pressure can be controlled. In this respect it is good to adapt the following conduct:

Periodic control of arterial blood pressure as the hypertension may evolve without symptoms after the age of 40 and in good health the blood pressure should be checked 1-2 times a year; after the age of 65, 2-4 times a year;
The food reach in calcium ( milk products, salmon, peace),in potassium (potatoes, and bananas), in magnesium (wheat, beans, pumpkin, seeds, fruits, vegetable), foodstuff rich in vegetables fibers, herrings, lower the arterial blood pressure
Physical exercises, 4-5 times a week, for 30-40 minutes have a beneficial effect on the arterial blood pressure;
There are drugs which retain water: cortisone products, non-steroid anti-inflammatory. Instead of ibuprofen you should use acetaminophen;
Classic music with low rhythm decreases the arterial blood pressure; also, the satisfaction of the profession and of accomplished work have the same effect;
The loss of body weight with 10-15 Kg (15-29 pounds) decreases the blood pressure up to 15 mmHg; the anticonceptive drugs and some antiulcerous drugs increase the arterial blood pressure;
The habit to relax yourself, to eliminate anger, anxiety and sharp words have the mission to create us a psychical comfort which induces the homeostasis (a normality) or internal area of the organism.
AVOID GAINING BODY-WEIGHT

With the advancing age, a normocaloric diet, reach in food principles, with regular meals and active leisure time lead to the maintenance of normal body weight. 10% over the normal weight increases the arterial pressure and the risk of having a stroke.

If your scales show you to be overweight, you should question yourself at least three times a day: a breakfast, lunch and dinner. A person does not live to eat, but he eats to be able to work, to create, to live and to enjoy living.

The great majority of those with overweight problems had arteriosclerosis, hypertension, poliartritis, diabetes, sexual impotence, or are handicapped after a stroke. The inmmunologic resistance and capacity to effort is decreased and frequently they have opportunity for diseases. Their average life span is statistically lower than of those with normal aging.

The presence of chronic diseases diminishes the quality of life. The people affected have physical and emotional suffering, the circadian rhythm (day-night) is disturbed, the capacity to work is affected quantitatively and qualitatively. They are those who go monthly to the drug stores, they become depended on drugs which after a while are not more effective, but give them cardiac, nervous and digestive disturbances.

In families these sufferings alter the relationship and often represents an additional financial burden. The implications are even higher in those of advanced age.

In all these it is well to think when our life style becomes unhealthy and when we feed our children.

In youthful years, an in the adult age, it depends on each one to prevent this diseases, or to make their presence have as little implications as possible on individual, microsocial family, or macrosocial community-society ground.

However people who have chronic sufferings, it is better for them to get used to and LEARN TO LIVE WITH THEM.

To the elderly with osteoporosis, poliartritis, circulatory disturbances, in order to prevent falling (fracture of the neck of femur is in 30% cause of dead at this age) it is recommended:

To avoid sudden movements from sitting position to an unexpected requirement;
To use the watch light on the corridors, or in the bathroom;
To control and correct their seeing, and hearing;
Be sure that are not toys or ether things in your way;
Look carefully, when you walk in the house, to the polished parquet, on the door threshold (a generator of cerebral hematoma, or different fractures);
Try and check if the chairs, table, or ether objects are well fixed, and put the electric cables linking wires, behind the furniture or near the wall.
To remove the loneliness, or the hard hours of those with Depression:

Try to do things which may remind of yourself: write a book, your remembrance, or to revise and to complete your diary;
Try to share your life and professional experience with your children and to people around you;
Choose a book for reading, listen to the radio, or watch on TV;
Call a friend and ask him to pay you a visit;
Do not do the same thing all the time, and search for agreeable, pleasant conversations;
Do not forget to allow time for meeting with friends, and go weekly to a senior club.
In order to alleviate and to eliminate the joint pains from chronic degenerative rheumatism and the osseous ones, profuse, from osteoporosis:

Carry out of your weekly program of physical exercises that is the most indicated and inoffensive treatment in this sufferings;
A Spa-cure for three weeks, twice a year, may be of much help to the alleviation of this sufferings;
In addition, the organized social entertainment program in this spas is beneficent for secondary depressive states associated with chronic diseases.
Organizing the way of life with a positive imagination and fancy by those with chronic sufferings is often the only remedy for these people.

Finally, the aging disease in its lingering form, and the life itself reflects the state of mind of those who have it.

Hydrotherapy

Water's therapeutic effect has a long tradition in chronic diseases especially in Europe.

The Roman's strong believe in the healing power of water, and caused them to build public bath wherever they came in, and used this to discuss policies to govern, famous so far: Montecatini (Italy), Baden-Baden (Germany) Herculane (Romania), Bath (England).

Neron, the Roman Emperor was convinced of the benefice effects of the water, declaring "Sanitas Per Aquas" (Health by Water), then forming the acronym (Spa) introduced in English language.

In the USA, "Spa" means any facilities including exercises and diet programs.

Famous writers, artists, and scientists benefit by, and appreciate the therapeutic effects of different spas: Marc Twain, Dostoievsky, Greta Garbo, Nicolae Iorga, Arghezi.

Some people consider mineral springs as holly waters.

Water is used as shower, baths, inhalation, or as drinking water in stomach, intestinal, billiary tract and reno-urinary diseases.

Hydrotherapy may be recommended in partial procedures: compresses, wrapping or bath. The bath for kinetotherapy are recommended at 36°C (100°F) in special tubs, or in swimming pools, were can be obtained a very good mobility of the upper and lower limbs. By under water massages the muscle contractions, the feeling of cold legs, and the neuralgic pains removed.

Hydrotherapy gives best results if is applied in certain SPAS, also due to the effect of the surrounding climate.
The climate of median altitude, or on the beach are considered as a sparing climate, and represent real ISLANDS OF LONGEVITY.
By taking the waters, the vegetative tonus, hypersympaticotonias and hyperparasympaticotonias normalize.
Tropical streams and oxidative substances in low concentrations stimulate the sympathetic nervous system.
The polar (arctic) fronts, the concentrations of negative ions strengthen the parasympathetic nervous system and the specific immunity.

In the elderly, and old people, the indications for hydrotherapy and watering cures are applied in relation with the biological age induced changes, and of associated chronic diseases.
In the elderly, the watering cures have notables features and the geriatrician individualizes and mention them when indicated in the treatment.

Hydrotherapy and other watering treatments have positive effects in the revitalization of the tissues, also help those who want to live longer, to be active and in a good health state.

PREGERIATRIC AND GERIATRIC EXAMINATION

Active and healthy aging is promoted by a prophylactic and curative examination, by a geriatrician in the Pregeriatric age (40-65), and in the Geriatric age (after 65).

In the early critical age (40-65) it is advisable to have a yearly check-up. On this occasion the physician establishes your degree of health, determines the gerontological diagnosis, estimates the biological age and the aging rhythm. The importance examination is of maximum importance for a good health in the following decades of life. It is the period in which the elimination of some risk factors leads to the prevention of coronary and cerebral vascular diseases, of arteriosclerosis, arterial hypertension, obesity, arthritis, diabetes of type 2 (non-insulin-dependent). By taking care of your health at this age, you may provide to yourself a healthy old age in a fully creative state, and independence.

After the age of 65, the geriatrician is confronted with a series of complaints which he should know and towards which he has to adopt differentiated attitudes.

A first concern in the elderly's clinical examination is that, the physician should show much discernment and understanding to search out the possible reasons which frequently may lead to an incorrect diagnosis.

The geriatric examination should take into consideration the fact that age induces clinical changes that we consider normal at this age, but which are abnormal for adult. A principle in the examination of the elderly is that paying attention to atypical signs that have little relevance. The more you try to find particular signs, the more you discover. The clinical history will be made with complete understanding and kindness. At the first contact the physician will try to eliminate the negativism and anxiety of the old person with a disabled sensorial background, or by any other diseases. The story should be comprehensive, and the physician should understand the family situation as much as possible, also, the elderly's attitude towards the doctor, hospital, followed treatment, and the psychical state.

There are gerontologists who considered that the clinical history should take 70-80% of the time allocated to a geriatric examination. Most attention should be given to the vital functions; any of their modification, which are often a typical has a significance.

LONGEVITY-FAMILY AND SANOGENESIS

Longevity is conditioned by genetic, physical and social factors. Epidemiological research has pointed out the ecological parameters involved in determining longevity. Clinical and laboratory observations have shown that the morpho-functional data of a longevous are very close to the adult persons' ones.

The psychological profile in longevous is characterized by a good adapting capacity to the environmental factors, a motivation of their actions, sociability and optimism.

Longevity itself is the result not only of some measures taken during the last part of one's life span, but it originates in a well balanced behavior preserved throughout the lifetime.

Physical Environment Factors

The highest percentage of longevous there are in altitude zones between 800 and 1000 m, and the lowest percentage, in plain areas.

As far as climate is concerned, the most favorable influence upon longevity is exerted by the marine climate.

The efficiency of sanogenesis - destined measures, in general, and longevity ones, in particular, is closely linked with the effort of protecting and preserving the natural environment against the noxious effects of pollution due to industrial and urban crowded areas.

In the past, the physical environment factors were directly conditioning the level of longevity, whereas today, as a consequence of the social and economical development, there is leveling tendency of the longevity indices from a territorial view point. In this context, it is understood that in the future there will be an increase of the social environment factors in determining longevity.

Social Environment Factors

The population health status is influenced by a lot of social environment factors. Among them, I shall mention only the most significant ones, which play a considerable role upon the health status and the lifetime: the education level, the social and economical security of the individual and his family, this average income per capita, the work legislation, the hygiene and sanitary conditions of the house and the food, medical assistance a.s.o.

Food characteristics. The social environment factors that favor longevity, the food one - that is, well-balanced, reasonable food plays the most important part. The majority of longevives have had mixed food throughout lifetime. For a long and healthy life of great importance are a moderate caloric in-take and the cooking, as simple as possible, of the food. Most of the people over 85 used to have 3 - 4 meals a day and had a regular eating schedule, with the main meal at noon.

Within the mixed food pattern, meat was moderately used, but enough for the necessary in-take of animal aminoacids, mineral substances and vitamins. In the great longevous menu (90 years old and more) a central place was held by lacto-vegetarian food. Fish is also considered to represent a longevity-favoring factor. Bread, pasta, animal fat, sugar and sweets are correlated with low longevity factors. In diary products areas (Vranvea, Ilfov) the there are high longevity indices.

It should be remembered that the present changes of the food pattern -both quantitatively and qualitatively- are meant to contribute to increasing the number of longevous on the population whole, but, given the frequent deviations from the reasonable principles of feeding, especially concerning the main nutritional factors equilibrium, there arises the perspective of a more numerous longevous population, but with health deficiencies. This raises the problem of mass education with regard to food - at all the age groups - as a component of prophylactic medicine.

The Family and Longevity

Between the sanogenetic psycho-social factors, the family life harmony generating satisfactions and achievements, influences the lifetime favorably.

Longevity, and especially its active side, is not offered as a gift, it should be gained. In fact, knowing how to gain it, knowing how to get old is equally a science and an art. As early as 1798 Hufeland defined MACROBIOTICS as the "science and art of life extension", and among the conditions for achieving that desiderate he mentions active life, to which he was remarking also that most of the longevous had been married. My data shows that there is only a small percentage of unmarried people among those over 85 (1-2%), related to the high percentage of the married ones (98-99%). The health state of the unmarried old people is deficient - up to 55% of the hospital patients.

A significant statistical aspect is represented by the high percentage - 88-90% - of the married longevous with children, out of whom 605 have seen even 4 children.

A family life based upon a harmonious relation and with its natural fruit, the children, has a major influence upon the health state. In such families the bond is so strong that the loss of one member - parent, child, wife - is a serious psychic trauma. It is a well known fact that psycho-sociologists grant a maximal value to that kind of affective stress.

The traditional family model is benefic in a double sense: the parents and the grandparents will feel their life fulfilled, and that is why they maintain their tonus and vigor by seeing their life and preoccupations continued by their children, and the children find around the grandparents the affective binder of the family, the good advice they may need - the fruit of experience and education. Old people's affection - to the extent to which it is equally shared among the descendants - means understanding, kindness and generosity without any conditioning or possessive tendencies as may be the case with adults.

To the question: where does an old person belong? - so frequently asked - I am answering clearly that he belongs to the traditional family pattern, with the required adaptations to contemporary life.

Transience, the accelerated rhythm of life, the informational out-burst, technicizing, all characteristics to contemporary society, have been changing the traditional models and concepts of family very fast. Psycho-social life is characteristic to the human being and the changes taking place in this domain have a deep resonance in the people's consciousness, with often unforeseen consequences.

THE ELDERLYS' LEISURE

Man needs an occupation, an activity, not only for social and economical reasons but also for maintaining the various functions of his own body.

Engaging people in certain occupations has been used as a therapeutic procedure for certain diseases - the so-called occupational therapy. The Greeks and the Egyptians used to apply the amusing occupational therapy in treating psychic disorders. In 1809, Philippe Pinell stated that regularly performed work was the safest way of maintaining the health state and the good mood of the retires people. Based on some experiments concerning the importance of occupational therapy, it can be concluded that a lot of patients with severe psychic disorders and a tendency to isolation may be guided to be active and towards a certain extension of their social relations. Thus, the old people are re-gaining the feeling of social usefulness close to their fellows.

The need of activity is felt at any age, but even more so at older ages, when the physiological needs and the psychological requirements are associated with experience and the habit of working throughout one's active life time. Prohlic in a paper entitled "In What Way Are Retired People Supposed to Organize Their Life" shows that the old people as well as the young ones do need affection, society, friendships, being useful for their social group. Of course, the every day life of old people has a certain rhytmicity, the active intervals and the resting time alternating with free time periods, which now require new dimensions.

For defining leisure, we should start from the time budget and the way in which it is distributed during the 24 hours. As regards the free time, there are different opinions concerning its definition as an interval within the 24 hours, and with regard to the specific activities performed in one's free time.

Even in the ancient time, the Greeks were using the word "Scholé" which has multiply meanings, like "free time", "stopping", "recreation", "inactivity", "lack of work", "idleness", "hobby", "studying", "conversation"; "Scholé" also refers to the place where the free time is spent.

Dumazedier J. and Ripert A. interpret as "loisir" any activity that answers a number of 4 criteria at the same time:

It should be free (independent) compare to work and other basic obligations;
It should be devoid of any utilitary purpose;
It should be aimed at getting personal satisfactions;
It should be guided by personal purpose of relaxation, amusement or instruction.
Free time frequently expresses the lack of obligation and a distinction from working time and free time absolute; the latter appears to be something outside the sphere of human obligations, some kind of time reserved to full individual liberty.
Dumazedier J. was considering free time as a sequence of activities to which the individual dedicates himself willingly, freely and with pleasure, in order to relax or to amuse and satisfy his own aesthetic needs. In addition, for enriching his general knowledge, for developing the voluntary social participation or his creating capacity, after having set himself free from the professional, social and family obligations.

Leisure can not be considered in isolation, it should be included in the temporal frame of society, in relation with the whole of the temporal relations located in the general frame work of the social and economical phenomena, being specific to each social system and the respective mode of production.

Depending on such characteristics, free time is differently defined in such a way as to keep it distinct from work time, and set up the activities which could be included in, or excluded from the time left after fulfilling the professional obligations.

The free time of the fully active man, which coincides with the work time proper (professionally) and the resting time, can be contrasted with the old age free time which, once the professional activities have stopped, acquires new dimensions. If free time can be defined as available time, without anything imposed, the retired person's free time appears as a continuous time, as a compact span, which he can dispose of as he pleases.

The old person is confused just because of the fundamental change all of a sudden that has occurred in his way of life as it used to be, due to canceling the professional life pattern which he had been accustomed to for a long time (20-30 years), which had represented a real stereotype.

If during childhood the time was fully allotted to playing or learning - under the continuous supervision of the parents and the teachers, and in adulthood the time was prevailed in distributing to the professional, family and social obligations, the sudden vanishing of such duties is meant to disorient the old people, to bring about a state of anxiety, by forcing them to establish their own work and life pattern.

Research performed by the Social Gerontology Group of National Institute of Gerontology of Geriatrics, where I was director (1978-1989), upon persons who had just completed their professional activity for few years, has shown that because of canceling the conducted program, some of the retired people were still unadapted, had a tendency towards isolation, apathy and depression. Such disorders are more frequent in men, immediately after retirement, later on, they got used to it and find an equilibrium by means of other compensatory activities.

As a matter of fact, it has been noticed that the use of leisure does not become a problem for all of the retired people. A number of old people are estimated to consider the cessation or their activity as representing the best way for them to achieve their most intimate aspirations accumulated throughout their life. They are happy to be set free from the professional obligations.

They can finally organize their new life with no intrusion, according to their wish, the wish that had been left unsatisfied before, because of the lack of time. Now, they can get involved in occupations uncontrolled by a boss and find satisfaction in an activity freely chosen and long wished for. This category includes the intellectuals and the workers.

Two different outlooks on free time may be distinguished:-

First, free time is not a determined category, it is rather a mode of behavior and any part of the day may be considered free time, even the one destined for work. In other words, free time is what the individual himself considers to be free time, if it brings satisfaction - be it during work or not.
According to the other conception, free time is the one set free from the control of the basic social institutions (professional, family, social, spiritual, political), fully dedicated to personal activities.
But the most important aspect concerning the old person's free time is linked not so much with the activities being carried out, but with the fact that such activities may answer some demands created by the cessation of professional activities. Research showed that in most cases old people feel the loss of their role and social position ensured by the professional activity as well as the absence of social contacts and every day relations with somebody else.

The free time is an individual one and the geriatrician has an important role. He should take into account the biological, psychological and social peculiarities of the elderly and the fact that this activity should compensate the previous one. The free tome is also population's time, a segment whose number is increasing and towards whom the society can not reaming indifferent.

Therefore, the problem arises to find the most indicated forms for an efficient use of this social time, so that the elderly to be maintained in an active life, and to bring his contribution according to his functional capacities to the creation of social values.

We should not forget: THE OLD PEOPLE MADE HISTORY!

Each old person represents a distinct biological and psychosocial entity, so the way that he organizes his time represents each person.

Organized with imagination, the free of old age may be our great friend and which only now could allow us the perfection and achievement.

With the advancing age, our own experience and the life experience of others give us the wisdom and helps us to use best the remaining time. During our meteoric presence, it is an ART TO KNOW HOW TO USE OUR ENERGY AND LIFE.

THE ART OF NOT WASTING TIME, BUT ON THE CONTRARY TO MULTIPLY IT, MEANS TO LIVE MORE LONGER.

THE DRUG OF INTELLIGENCE - GEROVITAL-H3®

The world in which we live requires from is sharpness, vigilance, ability, sexual wish and performance, high spirits, productivity, flexibility and capacity to change your profession, a context in which depression and nostalgia have no place.
Often we are tired and should however to bear another test, the pupil has another exam to take, and the old people does not remember quiet well the discussion he had a few days ago.

The first steps were taken in knowing the brain secrets. THE INTELLIGENCE is not only the prerogative of "Genetic Dowry". Memory, attention, concentration may be improved if we perform certain mental exercises, and live in a rich and varied milieu of information.

My personal researches and clinical experience in geriatrics, allowed me to outline a psychologic profile of the people belonging to senectude (the old age).
The analytic study of intellectual functions show a memory decrease for the recent data. Following the experience and the exercise, the possibilities of synthesis can be maintained.
Attention, concentration also suffer from the impact with senectude. In the sphere of instincts we are witnesses of different manifestations related to sex. It is important to signal the complexity of modifications appeared in the affective sphere, in the mind of those who cross the last stage of their life. Personality proves to be resistant to the elapse of years, and those no suffer important changes. There are well known the elderly's affective liability, their hyperemotivity and impressionability. The tendency to egocentrism, conservatism, "characterization" of some features of personality, slowing down of some cognitive functions, plead for the outlining of some types of psychologic aging. The deficits of cerebral functions in the third age become evident in the conditions of solicitations and emergency.
The old people need support and help, and if it is possible improvement of physical abilities, especially in the moments of tension and stress.

In the last few years we are witnesses to the impressive increase of drug number to influence the power of nervous cells. Dr. Dean Ward in a suggestive entitled book "SMART DRUGS" opens up the field of cognition-enhancing compounds.
I will take into account only the drugs which has a scientific support, which passed the psychologic test and which have no side effects, or whose adverse effects are minimal. Of course, the result requires an individual note, which depends on biochemical differences on superadded pathology, and on the combination of given drugs.

The elderly could respond to a singly drug, or to a combination of drugs, so that the geriatrician should analyses and differentiate carefully the physical and biological peculiarities.

We distinguish the follow categories of drugs:

The nootropic drugs

The term is taken from Greek language and means to act on memory, thoughts, ideas (soul). In this category there are included the products capable to improved memory and capacity.
Many researches suggest that this products act on acetylcholine system, playing an important role in memory mechanism and in those of transmitting the impulse from a nervous cell to another.
With the age, the acetylcholine production lowers and the role of nootropic substances would be that to reestablish its functional level.

The most important nootropic products belong to pyrolidine derivatives: piracetam, oxiracetam, aniracetam are similar with glutamic amino-acid from biochemical point of view. There are researches which suggest that under the piracetam influence the number of cholinergic receptors of nervous cell increases. In combination with choline and hydergine®, the effect on intellectual functions is evidently better. Hydergine® and piracetam seem to intensify their effects on the nervous system.
Piracetam although is a GABA derivative (gamma-amino- acid-butiric, a neurotransmitter). Piracetam and the ether nootropic products are indicated to improve memory, attention, concentration, in alcoholism disturbances, organic brain syndrome, Alzheimer's disease, different forms of dementia, for intellectual performances.
There are patients who, after using one of this products, state a feeling of brain "wake up". Adverse effects; include insomnia, agitation, headaches, gastro-intestinal disturbances.

Aniracetam is more affective that piracetam, its mechanism of action is not known and it does not seem to act on neurotransmitting systems: GABA, Catecholaminic, Serotoninic, or Acetylcholinic.

Other products belonging to the nootropic family:

Fipexide which improves recent memory, attention and coordination.

The product increases the dopamine level which is an essential neurotransmitter in the motor coordination, effective life and immune functions. No side effects have been reported after Fipexide administration, but this does not mean that they do not exist.
Pyroglutamate is a natural amino-acid which is found in fruits, vegetables, meat and it has an important effect on cognitive functions. In the patients with chronic/alcoholism and advanced atherosclerosis, it was noted and improvement of recent memory.

It is used also in the form of pyroglutamate of arginine. It is known as well under the name of Pyraglutargine, Arginine Pidolate.
Cavinton (Vinpocetine) is considered to have a role in improving cerebral metabolism and in the use of glucose and oxygen.

It is often used in the states after cerebra-vascular accidents, in aphasias, apraxias, dizziness, vestibular disturbances, headaches. The Gedeon Richter Company which commercializes it under the name of Cavinton, assigns to it some positive effects in 62%, in the patients with neurologic disturbances.
Other Cognitive Enhancers

Acetyl-L-Carnitine is naturally found in milk. Kohjimoto stated in 1988 that using it he obtained in laboratory a reduced quantity of lipofuscin in the nervous cells of some old animals. It is known that this pigment is accumulated in nervous and muscular cells with the advancing age. I should express my doubts and I consider necessary that this researches should be confirmed also by some other scientific workers.
Caffeine is widely/used in excess for its stimulating proprieties on the nervous cell. Numerous psychologic tests do not reveal memory improvement. Oborne, in 1982, notes that the alcohol combined with caffeine induce a higher state of intoxication that the alcohol alone.
To Centrophenoxine is assigned the quality of improving the learning performances and of reducing the quantity of lipofuscin in brain, heart and skin. Caution: it should not be administered to person with hypertension, increased excitability, convulsions. Side effects: insomnia, depression, tremor, nervousness. Other names: Analux, Cerebron, Lucidril, Mecloxate, Proseryl.
Choline and Lecithin can be found in food.
Dehydroepiandrosterone (DHEA) is a steroid hormone produced in the suprarenal gland to which is paid a special attention in the last time. It is assigned an important role against the obesity, cancer, generally tumors, and in aging. The level of this hormone decreases in blood with the advancing age.
Dimethylaminoethanoel (DMAE). Many effects are assigned to it; it induces high spirits, increases physical energy, improves memory.
Ginkgo biloba is used since old times for its vasodilating effect. The leaves of this tree, which dates for 300 millions years, is used in the Chinese traditional medicine.
It is recommended to those with peripheral circulatory disturbances, depression, memory disturbances, dizziness, tinnitus aureus, headaches. In "Clinical and Biological Research", 1989, Funfgeld presents a significant improvement after Ginkgo administration to patients with Parkinson's disease and Alzheimer's disease. Of course, there are necessary some other confirmations.
Ginseng. It is considered as an "Adoptogen", with homeostatic effect, against the stress, of tiredness state, it stimulates the nervous activity, hormonal and metabolic activity, potency. It is used by sportsmen as a good recoverer for tiredness. It slightly lower the suprarenal glands activity, a fact which explains the positive effect in stress states. The action is due to some substances named "ginsenoside", similar to saponines. It will be administered carefully to those with hypertension. In Chinese medicine, the treatment is well individualized. It can also be used as a tonic.
Hydergine®. This product is used even from old times in the form of ergot, in order to decrease hypertension in pregnant women. It is one of the most well studied drugs, as everyone should be studied, and it proved to be efficient and non-toxic.
The antihypertensive effect was analyses even from the years of '40, but only in the moment in which it was revealed also a possible effect in cognitive disturbances in old people, Sandoz Company analyzed it systematically. Among, others, the following effects are assigned to it: it increases the blood and oxygen quantity in brain by stimulating the nervous cell metabolism; diminishes and eliminates lipofuscin from nervous cell and protects from the harmful action of free radicals; it improves memory, learning capacity, as well as may indicators of intelligence, positively influences the dizziness, tinnitus aureus and tiredness; decreases the arterial blood pressure.

It was the first drug to which an efficiency was assigned in Alzheimer's disease (Branconnier, 1983, "Psychopharmacology Bulletin" Thomson, 1990, "New England Journal of Medicine") in dementia and in other psychical disturbances (Hollister, 1988, "Perspective in Psychopharmacology").

In case of supra-dosing it produces: nausea, headaches, gastric disturbances.

Idebenone resembles from chemical point of view to Coenzyme Q10 (CoQ10). CoQ10 has a determining role in formation of ATP molecules, the organism energetic source. CoQ10 is metabolized in a molecule with a high reactivity for free radicals.
Idebenone is on the contrary an antioxidative drug and it protects the cognitive functions of hypoxia, from the low level of oxygen in blood, the anticholinergic substances, and the low level of serotonin is correlated with a violent behavior.
Phenytoin is the drug which is administered in the epileptic crises. The medical literature is abundant also by other positive effects in phenytoin. The intelligence coefficients and the capacity of memorization were evidently improved during the treatment with this product. Among others, there are assigned to it the effects of retardation the aging process.
Often after the age of 65 we meet hypothyroidism, whose clinical symptomatology is poor and not noisy, and may be common to the picture of arthrosis, rheumatic polymyalgia, myopaty, chronic cardiac insufficiency. The elderly may present a state of apatia, depression, sudden mental bewilderment, dementia. The clinical data particular to hypothyroidism in old people should be known, analyses, compared with those of an adult, and made the therapeutic test for establishing the positive diagnosis. Under the substitute treatment it is noticed a rapid improvement of general condition, of attention, concentration and memory. This is the reason for which the thyroxin is used carefully in the improvement of cognitive functions.
Gerovital-H3®

GEROVITAL-H3® is one of the most widely spread treatment for aging. It was exciting for me, being collaborator of professor Ana Aslan more than 25 years, to hear her speaking many times about her experience with Gerovital-H3®. More than 500 medical and scientific publications referred to its beneficial effects, especially when Procaine was developed into Gerovital-H3®.

Ana Aslan herself was a living testimonial for her treatment. Aslan did the treatment with the Gerovital-H3® 27 years (sometimes I personally injected Aslan and she lived 91 years and 5 months.

The Institute of Gerontology and Geriatrics in Bucharest, Romania, where Aslan was general director (1952 - May 1988), gradually became the Mecca of diseased people. Scientist, physicians, businessmen, politicians, senators from all over the world moved came to learn from her, as well as to a undergo the treatment and listening to the testimonies of the old people who has regained the joy of life, returned to their favorite activities and found peace in their battles with insomnia.

She traveled in more than 80 countries to visit presidents of the states, prime ministers and universities where she presented her product and her geriatric method of treatment. Thousands and thousands of patients have spoken and written words that are proofs of the effectiveness of the treatment, which had brought so much relief and hope to the suffering.

In our conversations, between another questions I asked Aslan:
Among the measures of ten Commandments (Gerontoprophylaxis) you recommend the preventive treatment with Gerovital-H3®. In this respect, to which role do you attribute Gerovital-H3®?

"It is simple. Gerovital-H3® is the means by which suffering can be relieved. It is not the flower found by the abyss of seas by the lucky diver, Gilgamesh, the Summerian legendary who has discovered the secret of everlasting youth, but rather hope for the hopeless. After my treatment, the elderly enjoyed drinking from the fountain of spring water".
Professor Aslan knew that the fate and existence of her new product and her method of geriatric treatment all depended on the scientific community in Western World. She introduced Gerovital-H3® at the German Congress of Therapeutics, Karlsruhe, Germany in September 1956. This was a conscience decision, as Germany was the country in which Einhorn discovered Novocaine in 1905. Ana spoke German and knew the seriousness of these scientific meetings. Thousands of physicians participated every year. She spent all of 1956 preparing for this event and considered it a crossroad in her career and for Gerovital-H3®'s existence.

In 1956, the first International Acknowledgment arrived. Dr. Kienle, president of the German Congress, sent an official letter to the institute of Geriatrics in Bucharest:

"Karlsruhe, Dec. 11,1956

"Most Honored Sirs,

I can not resist the impulse which urges me to communicate with your Institute. In my capacity as the scientific guide of the German Congress of Therapy, as well as of German Exhibition of Drugs, and on behalf of all of us from the Congress, I call to your attention the active participation of Dr. Ana Aslan. Dr. Aslan addressed 6000 physicians this year at the Congress of Therapy. She presented the subject, "A New Method of Prophylaxis and Treatment of Aging by Novocaine-substance H3-An Eutrophic and Rejuvenating Action". The audience was very impressed by the importance of her research results and we are complimented that she presented them here for the first time.

"Besides the German Congress of Therapeutics, taking place September 1-6 1975, the International Congress of Therapy will be held Sept, 6-8, 1957. We would like to invite Dr. Aslan and her co-workers to participate in this Conference. We also request that she chair a symposium of the results of her scientific research. We are sure that she will communicate valuable results and add to the enrichment of therapeutics.

"I specially would like to thank you for facilitating her participation in the Therapeutic Congress of this year, and I express the hope that this contact will be susceptible to development in the future.

Dr. Kienle"

Foremostly, this level was taken to heart by Ana, as the soul needs to be comforted. But more importantly, it was the key which opened the locked doors and she was granted international travel.

Many conferences followed in which Aslan shared her research with Western medicine. After a conference in Berna, a Swiss physician declared, "For 50 years we have been using Novocaine daily, but only Aslan caught a glimpse of what a use it could be".

"It was a triumph, but yet I had to fight. Each conference was an examination which I had to pass with flying colors. When a question came up to which I didn't have answer, I took note and afterwards researched to find one. As a students and a young physician, I had no money and was unable to study abroad. These conferences were my education and I learned all that I could from each one".
"A new Method of Novocaine Treatment" was published in the Therapiewoche Journal 7, 1 / 2 October pages 14-22, 1956. This was the reference paper that initiated the series of more than 500 studies and research in International Literature to date. This paper presented the treatment method and results on 25 patients, between the age of 60-92, being followed since May 1951. Four patients, V.V. 91 year old female, E.G. 70 years old female, T.J. 66 years old male and T.M. 62 years old male, were presented in detail. This paper was a review of all the published literature up to date concerning to use of Novocaine and mentioned all the clinical, biochemical, physiological and hematological data used during the 5 years of treatment.

In conclusion, the evidence obtained by this long term administration of Gerovital-H3® authorized her to propose it and to ground it as a new method of eutrophic and rejuvenating treatment.

Numerous papers were then published that confirmed the method of administration and it was revealed as a new pharmacological aspect of therapy with procaine.

Lüth (1959) states that Aslan and Parhon were the first scientists who mentioned the physic effects of procaine. ("Procaine influence on the patient's physic condition was reported for the first time in the medical literature by the Romanian authors".)

Starting in 1958, Ana published and presented her own research on Gerovital-H3® treatment at the most important conferences and international meetings of gerontologists.

At the 10th Conference of the IAG (International Association of Gerontology) in Jerusalem in 1975, an entire session was devoted to Gerovital-H3® and its research. On that occasion William Zung, Eric Pfeiffer, Daniel Gianturco, MacFarlane, Peter Bridge, Ana Aslan, and others presented their results. Following this, Gerovital-H3® was imposed as a reversible anti-depressing drug without side effects. Also, its role was proven as a treatment for some degenerative chronic diseases.

In 1978, Aslan presented "Longitudinal Study in the National Institute of Gerontology and Geriatrics of Romania", at the 11th IAG Conference in Tokyo (Excerpta Medica, Amsterdam, pages 533-537, 1978). The results of the longest treatment ever (Beginning in 1951) aroused keen interest. With this Ana received more that 400 requests to present her paper.

In 1997, at the International Congress of Gerontology-Adelaide, Australia, Russu C. pointed out: "Within the normal oxidative processes of the organism there are produced also free radicals with negative role on the cells, specially on cellular membrane. Among the products with anti-oxidative role it is Gerovital-H3®".

Gerovital-H3® treatment may be individualized according to disease, to biological age and/or the aging rate. According to the way the patient reacts, the physician may shorten or prolong the rest intervals between the courses of treatment.

In a person with normal aging, the method can be used under the form of chronic of discontinuous treatment. In states of depression, memory disturbances (incipient forms of Alzheimer's disease), anxiety or Parkinson's disease, in which muscle rigidity is prevalent, Gerovital-H3® can be administered in a chronic form, too.

Indications of Gerovital-H3® treatment

Depressive states, physical and physical/mental asthenia, anxious states, accompanied by sleep disturbances, diminution of physical and intellectual capacity, neuro-vegetative dystonias and gonadic deficiencies due to age, and states of stress.
In the generalized dystrophy's (aging phenomenon) and in the localized ones (trophy and varicose malperforant ulcers, atonic wounds, burns and lesions by irradiations).
Skin, nails and hair dystrophy's (wrinkles, senile spots and keratosis, alopecia, pelade, neurodermitis, eczema, psoriasis, vitiligo)
Arthritis, osteoporosis, consolidation of bone fractures.
Arteriosclerosis prevention and of complications during the disease of cardiovascular apparatus system.
Parkinson's disease, neuritis and neuralgia.
Many times I have asked myself: What is life?. I think that life is a kind of joke of contradictions, a kind of "Yin & Yang" philosophy and, why shouldn't Gerovital-H3® be one of the factors that balances the complex functions of the body during the Critical Period (40-65 years) and old age?

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