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Surviving With Chaos
The traditional medical model of aging encourages us to think in terms of degenerating organs-a bad heart, a failing liver, a cancerous pancreas. But in the aging body, problems are often interconnected; the aging process puts pressure on all these systems, resulting in geriatric syndromes like incontinence, falls, depression, and dementia. None of these can be considered the domain of a single hospital unit or organ-based specialty.
"The geriatric syndromes are complex problems that can't be boiled down to one molecule or one cell," says Dr. Lewis Lipsitz, Usen director of medical research at the Hebrew Rehabilitation Center for Aged and an associate professor at Harvard Medical School. "We need better clinical tools to predict a person's vulnerability to disabling illness and to measure their frailty-that is, their impaired ability to adapt to stress."
Lipsitz is one of several Harvard researchers looking into the possibility that one of the body's most important defenses against stress has an unlikely name: chaos. On the face of it, the statement sounds absurd. Common English usage maligns chaos, with associations of disorganization and disarray. In fact, there's considerable beauty and structure in chaos. Chaos and the fractal patterns it produces trace the irregular outlines of seashores, mountains, and trees.
Likewise, the human body's organs and processes abound with chaotic fractal patterns. Chaos is an important component of a healthy heartbeat, of strong bones, of the branching structures of blood vessels, and of our natural walking stride. This built-in irregularity expands our repertoire of responses and allows us to adapt to the exigencies of everyday life. To remove the element of chaos from human physiology would reduce our resiliency and adaptive capacity; it would be about as productive as paving a coastline.
Lipsitz is also part of a group of researchers who have broken ground in combining chaos and geriatrics. He and Beth Israel cardiologist Ary Goldberger '70 have observed that as people age, heart function becomes much more regular and predictable (see "Arias from the Heart," March-April, page 22). Chaos may be the basis of new, sensitive tools to study aging and disease.
"Most of medicine is very reductionist," Lipsitz says. "You add up blood pressure, cholesterol, and throw in heart rate, and say someone's going to get heart disease. It's an incomplete picture. But that's the way we think.
"Now we're on the verge of using the underlying principles of chaos theory to look at all areas of physiological functioning. For example, a grandmother needs to go to surgery. We may be able to quantify her vulnerability to complications through measurements of chaos. A loss of chaos in the heartbeat's behavior might increase her risk of heart attack during surgery. Structural patterns in bone are also chaotic, and the breakdown of these patterns may tell us how fragile bones are, as opposed to how thin they are."
Gerontologist Jeanne Wei and Jeff Hausdorff, a Beth Israel bioengineer, have already designed a system for measuring irregularities in the length of walking strides that may predict the course of congestive heart failure. The applications of chaos to the study of aging may tell us a great deal more about the durability of people like Henrietta Aladjem and Ruth McShane, or the many other people whose extended lifespans bear witness to their ability to adapt.
All of us are going to learn a lot more about aging in the years to come-or die trying. For most of us, the knowledge will come from personal experience, and from those gone into the breach before us. The perceptions we build and acquire will have tremendous influence on our futures. As Tom Perls remarks, myths and generalizations about older people affect everything about their lives. He's particularly concerned about the provision of adequate medical care for chronic diseases of aging.
"Prostate cancer can take years to cause any serious problems," Perls says, "so some people tell their older patients, 'Look, you've got prostate cancer, but you'll probably die of something else before it kills you, so don't worry about it.' Well, if the patient's healthy and lives into his 90s with the malignancy, he'll wish he'd had it taken care of earlier. Everyone knows people in their 70s, 80s, and 90s who are in great shape, and it's those people that you better take care of. You can't fall into the paternalistic trap of thinking that you don't need to give someone complete, aggressive care, just because he or she is old."
Now that researchers have begun to shine a light down the dark hallway of aging, they are finding unexpected strength and resiliency in the elderly. They are relaying the message that we need not acquiesce in the imagined decrees of senility, that aging demands activity, participation, interaction, exertion. The next century's beginning will be well stocked with elderly people like Henrietta Aladjem, Ruth McShane, and Rose Silbermann. If we wish to emulate their longevity, productivity, and durability, we need to start listening and paying attention while we can.