The orchestration of disengagement.

In the clamor of many institutional and special interest "orchestras," it is possible to lose sight of their common object of concern-human welfare and dignity. In the sphere of scientific endeavor, this problem can show itself as a mistaken attempt to separate theory from technique and practice. Disclaimers that Disengagement Theory is "only a theory," not a policy statement, are regarded here as inaccurate and naive when the effects of the theory are examined. Other areas of criticism pertain to activity-passivity dynamics, the appreciation of coping behavior in later life, and, in general, the inadequate representation within Disengagement Theory of the full spectrum of experience, behavior, and dynamics, both personal and social, in the lives of elderly people.     

The meaning of engagement.

A distinction should be made between disengagement as a means of conceptualizing and as a means of explaining changes that take place with aging. The author is critical of those aspects of Disengagement Theory that emphasize inevitability, determinism, the separation of the individual from society, and the "crucial phase" model of development. An alternative viewpoint is sketched from the interactional analysis approach. Attention is given to the constant reinterpretation of self and situation, with consequent modification of actions. The facts of Disengagement Theory as seen from this perspective take on new meaning. Age-related changes are the outcome of the social circumstances within which they take place, along with the cultural values operating in that context.     

A disengaged look at Disengagement Theory.

This paper suggests that Disengagement Theory can be used as a theory of the middle-range, but not as a general theory about normal aging. This proposition is supported by an examination of key concepts, postulates and methods used to formulate the theory. By use of phenemological notions, we can see the concept of disengagement forces us to pay attention to the subjective meanings of aging people. It is necessary to disengage from the core statements of the theory and engage in a search for new methods to study the lived experiences of human beings in order to further our understandings of the processes of growing old.     

Disengagement theory revisited.

Cumming and Henry erected the basic frame for a socio-cultural theory of normal aging in their 1961 book, Growing Old. The basic postulates of this theory are reviewed, and the overall structure of the theory briefly examined. Critical data necessary either to accept or reject disengagement theory are not yet available, although useful information has been gathered since the theory first appeared. Part of the difficulty in amassing "proof" or "disproof" is inherent in the intricate and complex nature of the aging process itself. This orienting paper introduced a set of contributtions by other commentators on disengagement theory.     

Gero-transcendence: a reformulation of the disengagement theory

This article offers a meta-theoretical reformulation of the disengagement theory. It is argued that what social gerontologists describe in negative terms and label "disengagement" is in reality often a positive development towards gero-transcendence. This latter can be described as a shift in meta-perspective from a materialistic and rational view to a more cosmic and transcendent one, normally followed by an increase in life satisfaction. To understand the nature of gero-transcendence gerontologists have to make a meta-theoretical shift from a traditional positivist view to a view where disengagement is phenomenologically comprehended. As the article includes some criticism of interactionist-based social gerontology, it should be mentioned that the author himself has been and is working within this theoretical tradition. The article is as much self-criticism as anything else.     

Aging as exchange: a preface to theory.

After a brief review of the major concepts and propositions of the social-psychological theory of exchange, a view of aging as exchange is developed. Drawing upon the previous work of Blau and Emerson, problems of aging are seen as problems of decreasing power resources. Because power resources decline with increased age, older persons become increasingly unable to enter into balanced exchange relations with other groups with whom they are in interactions. From this view, the process of disengagement is the result of a series of exchange relations in which the relative power of the aged vis-a-vis their exchange partner increasingly deteriorates. An imbalanced exchange ratio consequently results in which the aged are forced to exchange compliance--the most costly of all generalized reinforcers--for their continued sustenance. The retirement phenomenon is specified as illustrative of the aging as exchange process.     

Free radical theory of ageing: Applications

Ageing is the accumulation of changes that increase the risk of death. Ageing changes can be attributed to development, genetic defects, the environment, disease, and the inborn ageing process. The major contributors of ageing changes after age 28 in the developed countries are endogenous chemical reactions, which, collectively, exponentially increase the chance of disease and death with advancing age. These reactions constitute the “inborn ageing process”. This process is the major risk factor for disease and death of the 98–99% of cohorts still alive at age 28 in the developed countries, where living conditions are near optimum. In these countries average life expectancies at birth (ALE-B) range from 76–79 years, 6–9 years less than the limit of about 85 years imposed by ageing. The Free Radical Theory of Ageing (FRTA) postulates that ageing changes are caused by free radical reactions. This theory suggests the possibility that measures to decrease the rate of initiation and /or the chain length of free radical reactions may, at least in some cases, decrease the rate of reactions which produce ageing changes without significantly depressing those involved in maintenance and function. Many studies support this possibility. Applications of the FRTA have been fruitful. For example, it is a useful guide to the efforts to increase the life span, and it provides plausible explanations for ageing phenomena, (for example, the association of disease with age as well as insight into pathogenesis, the gender gap, the association between events in early life and late onset disease, and the shortening of telomeres with cell division). Further, it is reasonable to expect on the basis of animal and epidemiological studies, that the increasing population-wide use of antioxidant supplements and ingestion of foods high in antioxidant capacity over the past 40 years have helped to increase the functional life span in the U.S.A. by contributing significantly to the decline in “free radical diseases”, to increases in the fraction of elderly in the population, and to the decline in chronic disability in this group.     

Gerontology and Education:

Since the early 1970s, educational gerontology has been active in both researching and advocating continuing education for older persons. However, very little has been states in this growing body of literature about how education in the later years relates to the process of aging itself, that area of inquiry which has traditionally been researched and reported by the much older body of literature known as social gerontology. In this essay, two longstanding social gerontological theories are analyzed for the ways they explain interest and participation in adult education on the part of older persons. While neither the activity nor the disengagement theory is explicit in articulating a relationship between the aging process and the need to learn, both do so implicitly. Implications from these social theories for educational program development are made as are recommendations for examining the present practice of educators and health professionals.     

How do we offer clinical relief to patients with gastro-oesophageal reflux disease?

In gastro-oesophageal reflux disease (GORD), the majority of patients are endoscopy negative. However, symptoms can affect the quality of life irrespective of the presence of oesophagitis. Proton pump inhibitors (PPIs) are far more effective than H2 receptor antagonists (H2RAs) or prokinetics with regard to the speed of symptom relief. Despite this undisputed progress, there is some conflict on whether symptoms should be managed until full resolution in endoscopy-negative patients or in those with mild oesophagitis. Considering that GORD is not a life-threatening condition, some authorities admit that patients should accept minimal residual symptoms. They argue that PPIs are expensive while healthcare resources are limited, and that long-term safety of PPIs has not been completely established. Moreover, they underline that many patients do not seek medical help and are satisfied with self-medication (with antacids/alginates or even over-the-counter H2RAs). On the other hand, some clinicians prefer a full resolution of symptom strategy because this is now achievable with modern PPIs without serious concerns in terms of tolerance and safety. Indeed, quality of life is rapidly restored by PPIs. Moreover, symptom relief by PPIs is highly predictive of healing, making endoscopic control unnecessary at least for mild/moderate oesophagitis. Finally, there is also some controversy over whether we should start treatment with PPIs or use less potent drugs as first-line therapy. If one considers not only the direct cost of drugs, but also the indirect ones (e.g. sick leave days), it is reasonable to think that PPIs may be more cost-effective than H2RAs or prokinetics, at least when the disease is of moderate or severe intensity. In conclusion, with modern PPIs like lansoprazole, rapid and full resolution of symptoms is now achievable in the large majority of patients.     

Blame and the couples dynamic

Guilt and blame are common in relationships in which one or both parties are HIV-positive; however, counseling may help these people manage their relationships better. One technique used by therapists is Control Mastery Theory, a cognitive, interpersonal, psychoanalytic approach that classifies behavior as either growth-promoting or pathogenic. Control Mastery Theory, designed to break the blame/rage cycle, is based on the theory that a person's beliefs are rooted in their childhood experiences. Therapists use the approach to help clients better understand their responses to their situation and to their partner. A case is presented of an HIV-serodiscordant couple who have years of mutual blaming. The therapist helps the couple explore the pathogenic beliefs underlying their behaviors so that they can gain greater control over their behaviors. To ease transitions during antiviral treatment success, therapists should pay attention to the unconscious, irrational beliefs underlying patient's behaviors.     

Negative interaction in late life: issues in the stability and generalizability of conflict across relationships

This study used an inductive approach to probe more deeply into the nature of negative interaction in late life. The data come from a nationwide longitudinal survey of older adults (N = 515). We began with two empirical observations and derived theoretical propositions from them that have not been explored extensively in mainstream gerontological research on negative interaction. First, the findings reveal that unpleasant interaction is quite stable over a 6-year period. This suggests that interpersonal difficulties are chronic stressors that may arise because at least some older people are involved in conflicted relationships that are difficult to terminate. The second empirical finding reveals that older adults who encounter interpersonal problems in one social relationship (e.g., with children) tend to encounter them in others as well (e.g., with friends). This suggests that some older people may play a role in creating the negative interactions they encounter.     

Hormontherapie und Anti-Aging

The desire for a long life is deeply embedded in nearly all men. Fortunately life expectancy has remarkably increased over the past decades, on the other hand advancing age is frequently associated with a rise in morbidity. Above simply prolonging life there is a need to search for strategies to improve the quality of life in the elderly. Different substances to prevent premature aging, cancer and degenerative disorders appear to be promising candidates. Since it has been suggested that the decline of different hormones over the lifespan is closely related to the aging process replacement of these hormones may be a strategy against aging. Especially hormones like growth hormone, DHEA, testosterone and melatonin were considered as anti-aging agents. This review is focusing on the theoretical background and the previously known effects of different hormones to slow aging processes. Despite some promising results in a variety of studies conducted over the past years presently available data do not justify the broad use of hormones for anti-aging purposes. However, although no single hormone can be recognized as a ‘rejuvenating’ and life extending agent, some of their actions may be beneficial for the aging process.     

Hormone therapy and anti-aging: is there an indication?

The desire for a long life is deeply embedded in nearly all men. Fortunately life expectancy has remarkably increased over the past decades, on the other hand advancing age is frequently associated with a rise in morbidity. Above simply prolonging life there is a need to search for strategies to improve the quality of life in the elderly. Different substances to prevent premature aging, cancer and degenerative disorders appear to be promising candidates. Since it has been suggested that the decline of different hormones over the lifespan is closely related to the aging process replacement of these hormones may be a strategy against aging. Especially hormones like growth hormone, DHEA, testosterone and melatonin were considered as anti-aging agents.This review is focusing on the theoretical background and the previously known effects of different hormones to slow aging processes. Despite some promising results in a variety of studies conducted over the past years presently available data do not justify the broad use of hormones for anti-aging purposes. However, although no single hormone can be recognized as a 'rejuvenating' and life extending agent, some of their actions may be beneficial for the aging process.     

The significance of brain aminopeptidases in the regulation of the actions of angiotensin peptides in the brain

From the outset, the concept of a brain renin-angiotensin system (RAS) has been controversial and this controversy continues to this day. In addition to the unresolved questions as to the means by which, and location(s) where brain Ang II is synthesized, and the uncertainties regarding the functionality of the different subtypes of Ang II receptors in the brain, a new controversy has arisen with respect to the identity of the angiotensin peptide(s) that activate brain AT₁ receptors. While it has been known for some time that Ang III can activate Ang II receptors with equivalent or near-equivalent efficacy to Ang II, it has been proposed that in the brain, only Ang III is active. This proposal, which we have named “The Angiotensin III Hypothesis” states that Ang II must be converted to Ang III in order to activate brain AT₁ receptors. This review examines several aspects of the controversies regarding the brain RAS with a special focus on brain aminopeptidases, studies that either support or refute The Angiotensin III Hypothesis, and the implications of The Angiotensin III Hypothesis for the activity of the brain RAS. It also addresses the need for further research that can test The Angiotensin III Hypothesis and definitively identify the angiotensin peptide(s) that activate brain AT₁ receptor-mediated effects.     

Life-span learning: a developmental perspective

The article discusses learning as embedded processes of development and aging, and as social activity over the life course. The concept of life-span learning is proposed and outlined to discuss these processes as aspects of and propositions in life-span development and aging theory. Life-span learning processes arise and continuously develop in a dynamically complex body, brain, and the mind they support as essential features of development and aging over the life course. Life-span learning processes are established by evolutionary adaptive mechanisms, enriched by challenging environments, and continuously developed in supportive social structures. These ideas are derived from evolutionary biology and psychology, the cognitive sciences, life-span development and aging research, and adult development and learning studies. It is argued that life-span learning activities that challenge the body-mind-brain nexus are indispensable to optimize individual development and aging. Three global interventions and their strategies are discussed that enhance life-span learning: Learning to Learn, Learning for Growth, and Learning for Well-being.     

Problem-Behavior Theory, Psychosocial Development, and Adolescent Problem Drinking

Problem-Behavior Theory is a social-psychological framework which helps to explain the nature and development of alcohol abuse, drug misuse and other problem behaviors. The aims of this paper are to present a brief overview of the theory, to review some of the research that has been generated and to appraise the usefulness of the theory when applied to drinking and problem drinking among young people.     

CHAIR-SITTING AND VARICOSE VEINS

Previous work indicates that varicose-vein development is unlikely to be due either to primary valvular incompetence or to congenital weakness of the wall. It is suggested that it represents an acceleration of the normal physiological dilatation with age, due to some factor in Western life which produces either excessive stress or a vein incapable of withstanding normal stress. The recent substitution of chair-sitting for ground-sitting in the life of Western man results in a substantial change in his saphenous vein stress environment. The hypothesis is advanced that this change, by altering either the resting calibre or the wall components, may be the cause of the high frequency of saphenous varicosis in the Western world. This theory is consistent with the relative or almost absolute freedom from this disease of Eastern and primitive peoples, respectively; and if it is correct, " varicose veins " is a preventable disease.     

At the Heart of Aging: is it Metabolic Rate or Stability?

Foundational changes in science are rare, but in the field of biogerontology there is a new theory of aging that may shake things up. The conventional wisdom about duration of life is based on an old idea known as the “rate of living” theory, which suggests that aging is caused by the loss of some vital substance. The modern version of this theory is that duration of life is influenced by the relative speed of a species’ resting metabolism. However, empirical evidence does not consistently support this hypothesis. In an article published recently by mathematician/biologist Lloyd Demetrius, it is suggested that the most important factor involved in duration of life is not metabolic rate or oxidative stress, but metabolic stability. If Demetrius is correct, his theory will have important implications for intervention research. For example, if the metabolic rate/oxidative stress theory is correct, efforts to intervene in the aging process should be directed at finding ways to reduce metabolic rate, lessen the production of reactive oxygen species (ROS), improve antioxidant defenses, or increase the quantity of antioxidants. If the metabolic stability hypothesis is correct, efforts to intervene in the aging process should be directed at finding ways to increase the stability of the steady state values of ROS, increase the robustness of metabolic networks, or improve the stability of antioxidant enzymes. For now there is reason to believe that Demetrius’ theory deserves further consideration – whether it meets the test of a paradigm shift has yet to be determined.     

The history of atrial fibrillation: the last 100 years

Atrial fibrillation (AF) has had a rich history that has touched the careers of many of the great clinicians and investigators of the 20th century. More recently, there has been an explosion of research into various aspects of the mechanisms and therapy for AF, as evidenced by over 8,000 publications on AF from 2000 to 2007. A century of research and clinical observations, coupled with modern investigative technologies, has enabled modern investigators to have their own "fantastic voyage" as they travel beyond the cell borders into the ionic mechanisms responsible for AF and its many atrial perturbations. One can only imagine the satisfaction of Wenckebach, MacKenzie, and Lewis if they could see how their seeds of wisdom have grown into such sturdy ideas, or how delighted Scherf would be to learn that his ectopic focus theory for AF has been given new life.
This paper on 100 years of AF was initially prepared for presentation as the Plenary Lecture at the AFib Summit for Heart Rhythm 2007 in Denver, Colorado. I have tried to provide the reader with some of the most important observations on AF, realizing that it would be impossible to include all or even most of the major research done during this time frame. I apologize to my many colleagues whose research has helped us to understand better the clinical and basic aspects of AF, yet who could not be cited for lack of space.