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Sessions on aging offer advice on health, sexuality

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Attendees at the two "Aging Successfully" lectures learned about new knowledge of familiar health problems associated with aging, such as arthritis and strokes, as well as issues of aging and sexuality.

The panel discussions, held on April 8 and 16, were organized by Catherine N. Stratton and sponsored by the Medical Department and the Women's League.

"New Approaches to Old Problems: Good Stories," a panel moderated by William Kettyle, associate director of MIT Medical, discussed current research on ulcers, arthritis and strokes and explored how new research into these problems might affect older people.

Professor James Fox, director of the Division of Comparative Medicine, introduced a "new paradigm of ulcer disease as infectious. In the old model of ulcer disease, the cause was excess stomach acid and the treatments ranged from a bland diet to surgery. In the new model, ulcer disease is actually a symptom of the presence of Helicobacter pylori, and the treatment is an antimicrobial regimen."

H. pylori infection is the "most common infectious disease -- 50 percent of the world's population is infected," noted Dr. Fox.

Dr. Simon Helfgott, a rheumatologist at Brigham and Women's Hospital and assistant professor of clinical neurology at Harvard Medical School, discussed the etiology of arthritis, differences among types of arthritis, and new approaches to treatment. He expressed compassion for the pain and other systemic symptoms -- including debility, malaise, fatigue and fever -- and emphasized there is "no evidence that slowing down activities" was helpful.

"Don't underestimate exercise or muscle-strengthening techniques," he said.

Dr. Helfgott also commented on research on the role of immune responses to strep, rheumatic fever, chlamydia and salmonella in relation to arthritis.


Lee Schwamm, assistant director of the Acute Stroke Service at Massachusetts General Hospital and associate program at MIT's Clinical Research Center, opened his comments on an optimistic note.

"It's a pleasure to be a neurologist interested in strokes in the 1990s. We used to hear, when there'd been a stroke, 'diagnose and adios.' Today that's not the case," he said.

Dr. Schwamm emphasized, however, that strokes are still the leading cause of long-term disability and the third-leading cause of death in the nation. "Essential are rapid diagnosis and early treatment. Remember: 'time is brain!' If your arm suddenly goes weak, don't take a nap -- call a doctor! Call 911!

"If you are a witness to a stroke, or anything that might be a stroke, write down the time the episode started and anything you saw," Dr. Schwamm told the audience. This information can be critically helpful to effective treatment.


"Sexuality and Aging," the second in the Stratton series, was moderated by Peter Reich, chief of psychiatry at MIT Medical. Dr. Kettyle, an internist and endocrinologist, opened the session.

Derek Polonsky, assistant clinical professor at Tufts and Harvard Medical Schools, discussed changes in the physiology and the psychology of sex and sexuality as people age.

"It's important to be comfortable with one's body and to have an ability to be open, to share, to trust, and to be able to express and resolve conflict," he said. "Research shows that people now have increased expectations about continuing to enjoy an active sex life into the later years and that satisfaction with sex is improved, rather than impaired, with age."

Dr. Polonsky also noted that changes affecting older people -- divorce and death -- bring up dating issues, creating new anxieties and worries about body image and performance. "Performance is overemphasized," he added. "Everything just takes longer."

Katherine Wolf, a psychiatrist at Mt. Auburn Hospital and an instructor at Harvard Medical School, commented on her experiences as a geriatric psychiatrist (she sees no patients under age 65).

"Old patterns of behavior persist throughout life, but there are changes that happen to the self between 40th and 50th birthdays. Older people are more likely to ask for help and to understand that emotional problems can be healed; they also do get further in recovery from depression than younger ones. As men age, they do become more psychologically minded; they are more likely to seek treatment than younger ones," she said.

Dr. Wolf listed "three emotional square meals" -- meaningful work, contact with other human beings, and some enjoyment or pleasure, including sexual activity -- as essential to mental health. She also noted that libido-inhibiting effects of illnesses, medications, depression and cultural attitudes about sexual activity itself can take a cumulative toll.

"One of the most remarkable changes in my lifetime has been the opening up of issues of homosexuality. Their awareness of their own sexuality has been a great benefit to us," Dr. Reich said.

Gay couples in committed relationships share issues with all couples, including the need to manage conflict and communication, Dr. Polonsky said. "If multiple partners is part of a person's lifestyle, then age presents a challenge that can lead to depression, due to the loss of attractiveness in a youthful market."

A general discussion engaging both panelists and audience members focused on issues of sexual activity and conjugal visitation where one or both partners lives in a nursing or retirement home.

"Older people should stand up and insist on a private room, even saying, 'I need this time and space for a conjugal visit," said Dr. Wolf.

A version of this article appeared in the May 5, 1999 issue of MIT Tech Talk (Volume 43, Number 29).

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