Category Archives: Health in old age

Retirement, and the destruction of our financial system.

140530_retirementThe number of people over 65 is set to double within 25 years. By 2035 Japan will have 69 old people for every 100 of working age (up from 43 in 2010), and Germany 66. In China the dependency rate will double from 15 to 36. By 2050 China will have 440 million pensioners or more than the projected population of the US!

Most countries have the PAYG system whereby the workers pay for those in retirement. When the scheme was initiated there were about 7 workers to pay for one retiree. In Europe there are now almost 4 people of working age to pay for each person over 65. They are now paying far more than when the scheme was introduced. Increasing the payments further is politically impossible. But by 2050 the number of workers to pay for one pensioner will be halved to about 2. The system is obviously unsustainable.

Unless the retirement age is changed there will be relative fewer and fewer workers to pay for more and more of the retired.  Not only will there be more retirees but they will live longer and pensions will have to be paid for increasing longer periods. Already in Germany, retirement for a female lasts 20 years. It has been estimated that 20% of those living today will reach 100; Thus having a retirement lasting 40 years!   Financing pensions with the present scheme will then be impossible.

Under the UN`s assumption that a working life ends at 65 and with no increase in productivity, ageing populations could cut growth rates by between one third and one half over the coming years (Economist 411(8884): 18). This is probably an over- optimistic view.

Not only is there no increase in productivity growth, but there is a growth decrease from 2.2% in 1971-2007 to only 0.3% per year since 2008!

All these factors help to explain why the UK has unfunded pension obligations of a staggering £4.7 Trillion (with a GDP of £1.5 Trillion). This amounts to £180,000 per person (Office of Nat. Statistics.). The National Debt would be increased 5 times if the unfunded pension obligations were added. The UK Government has pension liabilities of over 300% of GDP. In Poland and France they are over 350% of GDP (FT 23rd Aug. 2016).

While these figures can be questioned, it has been estimated that if the US pension liabilities were to be added to the US National Debt, the debt would be increased 7 times!    Federal unfunded liabilities alone exceed $127 Trillion or $1.1million per taxpayer (Forbes, Jan. 2014). US pension liabilities have increased 6 times over the last 10 years, (Harvard Kennedy School; “Unfunded Public Pensions in the US”).

The FTSE 100 global companies with pension schemes had a net pension deficit of 290 Billion Euros in 2011 or nearly double the amount of 170 Billion Euros in 2010. (A pension deficit of 170 Billion Euros is more than the Greek bailout package).

An example of the enormous burden of pensions schemes on individual companies can be illustrated by the BT Group (UK). The pension liabilities are estimated at £47 Billion and the company has a market capitalization of only £35.5 Billion. The Pension Fund is 1.5 times larger than the size of the company!   The UK `s 6,000 schemes had an aggregate deficit of close to £300 billion (FT Aug.12th 2016 p.8). IBM has pension obligations of a staggering $99.7 Billion, (Fortune Nov. 2014).

There is a bright spot. Britain`s Pension Protection Fund to protect workers pensions had a surplus of £3.6 Billion. The American Pension Benefit Guaranty Corporation on the other hand, had liabilities of $164 Billion with total assets of only $87.7 billion; a record deficit of $76.3 billion. Congress has provided a levy of £27 per employee per year. This is $270 million, which is woefully inadequate to cover a liability of $52 Billion. (Economist, April 9th 2016, p.62). The severity of the problem has not been realized.

The idea of pumping more money into the economy or “quantitive easing” with historically low interest rates to revive the economy, has resulted in global debt increasing to $200 Trillion; far outpacing growth. (This amount is greater than the world debt before the financial crisis (McKinsey Survey)). The extreme low rates of interest have resulted in a massive increase in pension fund liabilities. The liabilities of pension funds in the US are now double their assets.  (They had a surplus 30 years previously)!

There is fear that some states, cities and pension funds may have to declare bankruptcy, due to pension liabilities. The City of Detroit was declared bankrupt with half of the debt being pension debt.

While some figures may be questioned the fact remains that retirement is massively bleeding the world economy, by reducing the relative size of the working force, (thereby reducing productivity), through ever increasing massive pension demands on the state, cities, companies and pension funds (thereby reducing investment). It is no accident that the economy stagnates.

The figures are enormous. They are frightening (G. Magnus) and are increasing by a huge amount every minute, as more and more people become older and older. The figures have been ignored because the pension debt and liabilities are not on the balance sheets. But they have the potential of causing a world financial crisis with our children and grand children living in poverty.

Unless the present retirement system is completely overhauled, and the elderly incorporated into the working force, making a contribution to society, the world will face a human disaster.

Cancer and Exercise.

English: Nutrigenomics: bring disease, cancer,...

English: Nutrigenomics: bring disease, cancer, diet and genetics together (Photo credit: Wikipedia)

Recent press articles in the UK have trumpeted the alarming fact that “Half of the UK population will get cancer in their lifetime,” but if one reads further through the reports there was also another eye-opening claim:  “Exercise is so effective in the prevention and rehabilitation of cancer, that if it were a drug; it would be a wonder drug.”

Why am I not surprised? In my mind, these findings lead me to imagine a situation in which it is suddenly realized that that food (even in minute portions) is now the new wonder drug to cure  famine!

The tragic reality is that the vast majority of the population suffers from exercise hunger or acute chronic exercise deficiency. Inactivity is now the 4th preventable cause of death. Based on a survey of 153,000 people, only 5% of UK adults meet the minimum physical activity recommendations. (NHS Sport & Exercise Medicine Sept. 2011) and only 3% do not smoke, have normal weight, eat 5 fruits and/or vegetables per day and exercised sufficiently. (Ach. Intern. Med. 165:854, 2005). On the other hand, regular exercisers are up to 50% less likely to be affected by serious illness, including cancer. (NHS Sport & Exercise Medicine Sept. 2011).

45% of the US population has at least one chronic disease (including cancer). By 2025, it is estimated that the proportion will increase to 49%, or about half the population! Behavioural risk factors for chronic disease include physical inactivity, an unhealthy diet and smoking. (WHO).

In spite of the fact that the intimate details of the preventive and curative aspects of exercise are not widely known, efforts are being made to develop special training regimes and specialized coaches for specific medical conditions. The ACSM/ACS (USA) offers courses for a “Certified Cancer Exercise Trainer”, with requirements that include a Bachelor’s Degree. (American College of Sport Medicine).  In principle, this is a development I welcome, though much more research is necessary.

I am, however worried that, it is readily forgotten that exercise must be combined with diet in order to achieve the desired results. Diet should be tailored and timed to the training regime. Certain dietary components that were present in the mid-Victorian diet contain enzymes that induce cancer cell arrest. (J.R.S.M. 101(9):454 2008). These components and avoidance of the carcinogens present in many modern foods should be incorporated. I’m convinced that reduced energy expenditure or lack of exercise and the increased consumption of processed and less nutritious foods are the main causes of the dramatic continuing increase in chronic disease.

A specified training regime, for cancer patients, administered by a certified cancer exercise trainer together with a diet, tailored to the exercise regime as well as being anti-carcinogenic seems a valid prescription.  Sadly, the recommendation is often just a short walk.

Perhaps the cancer patients are often so weak that even a 30 min. walk is very demanding or the knowledge of exercise and it’s inter-relationship with nutrition is sparse. Either way, both are disturbing.

Causes of Knee Osteoarthritis.


Knee (Photo credit: mariandy_gizfel)

I have talked about the extraordinary and disturbing number of knee joints that are being replaced by artificial joints. There are 600,000 knee replacements every year in the US at a yearly cost of $9 Billion. They have doubled over the last decade. (OECD iLibrary 2011). They are expected to double again in the UK over the next 2 decades! (Lancet 380:1768 2012).

Age is a factor. 70% of those 65+ show radiological evidence of osteoarthritis in at least one knee or hip joint. (J. Orthop. Res. 7:15 2012)

But one of the major causative factors is obesity. 69% of knee operations may be attributed to obesity in Croatia (Ljec. Vjesn. 131:22 2009). If all overweight and obese people were to reduce weight by only 5Kg., or until their  BMI was within the normal range, 24% of OA knee surgical cases could be avoided.! (Int. J. Obes. Relat. Metab. Disord. 25(5):622 2001). Some surgeons do not operate until the patient has reduced his BMI. A BMI of 40 is considered inoperable!

Another major cause of osteoarthritis of the knee, which is rarely discussed, is inactivity. The synovial fluid of the joints is viscous and cannot function unless the joint is put under pressure. 40% of men with knee osteoarthritis are couch potatoes (Northwestern Univ. News Aug. 2011). Lower extremity muscle weakness is a risk factor for knee osteoarthritis (Arthrit. & Rheum. 41(11):1951 1998). Low muscle strength is strongly associated with knee pain, (Ann. Rheum. Dis. 57:588 1998) and muscle weakness may be an im portant factor in the pathogenesis of osteoarthritis. (Rheum. Dis. Clin. N. Am. 25(2):283 1999).  Such patients require not only rehabilitation after the operation  but “prehabilitation”, to increase necessary muscle strength,  before the operation!

Age-standardised disability-adjusted life year...

Age-standardised disability-adjusted life year (DALY) rates from Osteoarthritis by country (per 100,000 inhabitants). (Photo credit: Wikipedia)

Man is the most destructive animal that has ever existed on the planet and efforts are being made to protect animal and plant species. However there seems little effort to protect the human species from the man made destruction of human health.

We are already at a point where we have to be treated to give us sufficient minimal health in order that we can be treated.

Contrary To General Opinion

University of Birmingham Medical School, England.

University of Birmingham Medical School, England. (Photo credit: Wikipedia)

Professor Janet Lord made an interesting presentation at the first AgeWell Conference at the University of Birmingham 2010, entitled “How to maintain a healthy immune system in old age”.

She was quoted as saying that, “the immune system declines with age”. However I have experienced exactly the contrary.

I am very nearly 94 and have experienced a dramatic improvement in my immune system during the last 3 years. Previously I suffered a cold just once a year- usually in November. During the last 3 years I have not had a cold nor suffered any complaints, or illnesses whatsoever.  I no longer have a doctor.

Contrary to general opinion I believe that high intensity training and muscle building in old age are essential factors for successful aging.

All This Nothing We’re Doing Is Actually Killing Us

All this nothing we’re doing is actually killing us.

via All this nothing we’re doing is actually killing us.

English: On overweight man's waistline.

English: On overweight man’s waistline. (Photo credit: Wikipedia)

High praise indeed- and supporting this argument the Economist published a special report on “Obesity” (Dec. 15th 2012). Roughly 1/3 of the world’s adult population is either overweight or obese. It is estimated that this number will increase to 2/3 of the world’s adult population by 2030 (Jiang He at Tulane University).

This could have devastating consequences for the human race. What was not mentioned is the fact that obesity shrinks the brain.  It has been estimated that 4% of the brain mass is lost with overweight and a staggering 8% with obesity. What would the future for our grandchildren look like, with only a third of the world’s population having normal brains?

S.O.S. – “Save Our Sanity!”

High Intensity Resistance Training

3-d model of IGF-1

3-d model of IGF-1 (Photo credit: Wikipedia)

Although there seems to be considerable research on the benefits of mild aerobic exercises in this regard, there are suggestions that vigorous aerobic activity (A.J.H. P 26(6):333 2012),  high intensity training and diet ( J. Alzheimer’s Disease 28(1):137 2012),  or resistance training (Arch. Intern. Med. 172(8):666 2012) are beneficial.

Also insulin-like growth factor (IGF-1), hormones and second messengers encourage neurogenesis, synaptogenesis and angiogenesis in the brain, which improve brain health. (Klinik Psikofarmakoloji Bulteni suppl. 2 21:91 2011). However, increased production of IGF-1 and hormones, such as testosterone, occur as a result of or hypertrophy training and not with aerobic or endurance training.

In addition, multi-tasking  and neuromuscular training have been shown to be beneficial for cognitive functioning.

There is not enough done to promote active lifestyles of the aged.

Gym Free-weights Area Category:Gyms_and_Health...

Gym Free-weights Area Category:Gyms_and_Health_Clubs (Photo credit: Wikipedia)

There is not enough done to promote active lifestyles of the aged. The main problem is the fact that too little is known. Research on physical activity, diet or even the effect of work on health in old old age is practically nonexistent above the age of 70. It is a shocking fact that there are far too few healthy individuals above the age of 80 to be able to conduct meaningful research.

Responsibility rests with research facilities and promotion by government as well as health agencies. Most private health clubs do little or nothing to attract older people as members in spite of the fact that the aged have sufficient time and money.

Research has shown that older people prefer to train in groups of their own age. Besides this, the older member should be tested and goals set. The member should be retested at regular intervals and the results sent to their physician.

The results would become part of the patient’s medical history. Membership could in certain cases, as in Japan, be restricted to those above 70, or have an off-peak membership for the elderly. Ideally the coaches should also be of the same age group. Treatment of disease by exercise is receiving more attention by the medical profession but there is an extreme lack of cooperation between physicians and health clubs . This could be a huge opportunity. Almost all over 65 have one or more chronic diseases.

Some clubs in Germany are licensed to treat diabetes with exercise. Clubs could institute a food service together with supplements. There is so much more that clubs could do to attract more older people and I would be happy to discuss individually with every leisure chain CEO what could be beneficial.