International Society for Aging and Physical Activity

Spring 2000

Table of Contents

What Was The International Year of Older Persons?

The First Arab Regional Congress of Rehabilitation International and the Second Gulf Conference in Medical Rehabilitation (Safat, Kuwait)

The 5th World Congress on Physical Activity, Ageing and Sports (Orlando, USA)

The First International Conference on Aging (Tehran, Iran)

International Gerontology and Geriatrics Conference (Pune, India)

How to Contribute to the ISAPA Newsletter

President's Update

A great deal has happened since the first ISAPA general meeting in Orlando in August 1999. The ISAPA www site is now fully functioning at http://www.isapa.org/. The web site includes an interactive bulletin board on which members can post messages and replies, a calendar of forthcoming events, hundreds of physical activity and aging links, dozens of graphic images for you to download, and many other features.

During the last six months the ISAPA World Congress Sub-committee has worked hard soliciting applications to host the 2003 World Congress on Physical Activity and Aging. An announcement about the site selected for the 2003 Congress will be posted on this site by the end of March 2000. ISAPA has appointed a webmaster to supervise the growth and utilization of the www site. An electronic mailing list of more than 1000 physical activity and health professionals has been constructed. More details about these exciting developments are provided below.

1. ISAPA website names new webmaster:

Dr. Michael E. Rogers, Director of the Center for Activity and Aging at Wichita State University in Kansas, USA has agreed to serve as the first webmaster for ISAPA. The webmaster controls the posting of new content on the ISAPA website and works closely with the computer staff at Human Kinetics Publishing. Michael has been very helpful in overseeing the establishment of the Bulletin Board on which you can place messages, ask questions, and share information. As more and more ISAPA members become aware of the Bulletin Board, we anticipate that this service will be widely utilized for the dissemination of information. If you are searching for a particular testing protocol, wanting to advertise a forthcoming event, or simply if you want to comment on some aspect of activity and aging, feel free to use your bulletin board!

The ISAPA site is an excellent location to place links to your laboratories, calls for papers for forthcoming meetings, post images of active seniors etc. Faculty teaching courses in the area of aging and physical activity can exchange lesson plans, syllabi etc.

If you would like to place information on the ISAPA www site feel free to contact Michael Rogers at the following e-mail address: michael.rogers@wichita.edu

2. Three Sites Evaluated for 2003 World Congress:

The World Congress Sub-committee chaired by Dr. Roberta Rikli issued a request for proposals to host the 2003 World Congress on Physical Activity, Aging and Sports. The call for proposals was announced at the 1999 Annual Meeting, posted on the ISAPA www site, and mailed to a large number of interested parties. By the December 31, 1999 deadline proposals had been received from Canada, Hong Kong, and the United Kingdom. The proposals have been evaluated by the World Congress Sub-committee who have forwarded their recommendation to the ISAPA Executive Committee. The Executive Committee will vote on the site selection in March 2000. The results of the selection process will be announced on this site.

3. Why you should join ISAPA now:

As many of you know, in 1999 membership in ISAPA was free to JAPA subscribers and all individuals who attended the 1999 World Congress in Orlando, Florida. In 2000 our challenge is to convince you to continue your membership!

We believe that there is a clear need for a professional society for health and physical activity professionals with interests in aging and activity. ISAPA is designed to be a membership-based academic organization society with a democratically elected and representative Executive Committee. The mission of ISAPA is as follows:

To promote physical activity, exercise science, and fitness in the health and well-being of older persons.

To promote international initiatives in research, clinical practice, and public policy in the area of aging and physical activity.

To organize a World Congress on Aging and Physical Activity approximately every 4 years.

To serve as a liaison between various international, national, and regional professional groups with an interest in activity and aging.

To disseminate information about aging and physical activity through journals and other publications.

If you join ISAPA you will benefit in the following ways:

A biannual www based newsletter

A subscription to the Journal of Aging and Physical Activity

Access to the ISAPA world wide web site, including an electronic bulletin board

Updated information on Aging and Physical Activity, including recent initiatives, position stands, and conference announcements

15-20 percent discount for registration at all future World Congresses

Potential registration discounts at other international academic conferences

A $5 discount coupon which can be applied toward the purchase of any Human Kinetics book or publication.

Registrations are only $60 for US Residents which includes a one year subscription to JAPA.

Current JAPA subscribers can add an ISAPA membership for only $16.

You can register conveniently by following this link to the ISAPA membership page: http://www.isapa.org/Membership_Info/

4. ISAPA will publish proceedings of the 1999 Borchard Symposium:

ISAPA is pleased to announce that it will publish the proceedings of the 1999 Albert and Elaine Borchard Symposium on the Future Role of Regular Physical Activity in Successful Aging.

In July 1999, the Albert and Elaine Borchard Foundation sponsored a three day colloquium which was held at the Chateau de la Bretesche in Missillac, France. Eight researchers, clinicians, and public health officers from Europe and North America were invited to come to Missillac to discuss issues related to the importance of regular physical activity in successful aging. The colloquium was scheduled to coincide with the United Nations celebrations for "1999 - The International Year of Older Persons". The participants were chosen to reflect a variety of different research, clinical, or public health perspectives. Speakers were specifically asked to avoid the traditional approach of reviewing previously published literature. Instead the speakers were encouraged to consider the Symposium as an opportunity to speculate about future developments and initiatives in their particular area of expertise, and demonstrating how these approaches can been applied to improve the quality of life of older persons. ISAPA is pleased to announce that in March 1999 an edited version of the Borchard Symposium proceedings will published on the ISAPA www site. ISAPA is excited at the prospect of extending other electronic publishing options in the near future.

New developments in the growth of ISAPA will be posted on this page. Please check back regularly to keep yourself up to date on developments in your organization. Be sure to visit the site in March to learn the outcome of the World Congress 2003 venue selection and to read the 1999 Borchard Symposium Proceedings.

If you have any comments or questions about ISAPA, or if you wish to volunteer to serve on an ISAPA subcommittee, please feel free to contact me at anytime.

Wojtek Chodzko-Zajko, Ph.D.

President, ISAPA

isapa@kent.edu

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What Was The International Year of Older Persons?

Michael E. Rogers, Ph.D., ISAPA Newsletter Editor

The world observed the International Day of Older Persons for the first time on 1 October 1991. One year later, the UN General Assembly designated 1999 as the International Year of Older Persons (IYOP). On the 8^th observance of the International Day, 1 October 1998, the IYOP was launched in recognition of "humanity’s demographic coming of age and the promise it holds for maturing attitudes and capabilities in social, economic, cultural and spiritual undertakings, not least for global peace and development in the next century".

During the IYOP, local, national, regional and international initiatives raised awareness of the issues related to aging. Information campaigns, conferences, debates, art exhibits, web sites, walks, and fairs were conducted to bring attention to the issues. It was hoped that the IYOP would:

improve livelihood, security and health care for older persons
introduce new and improved language, images and ‘scripts’ for late-life
recognize mid-life as a transition to active ageing
provide greater youth foresight and awareness of longevity
strengthen networks of family and community caring
develop more channels of communications between the generations
form more flexible lifelong work arrangements
structure more formal and informal lifelong educational opportunities
recognize the achievements and rights of older women
institute more multi-generational industrial design
initiate policy-oriented research on aging for the next decades
coordinate future-oriented national and international programs

(http://www.un.org/esa/socdev/iyop/iyopaag.htm)

In 2001 the UN General Assembly will evaluate the success of the IYOP in achieving these goals and prepare further plans.

This issue of the ISAPA newsletter summarizes some of the events that occurred during the IYOP, providing highlights of the issues addressed, activities performed, and projected outcomes. A full calendar of IYOP events can be found at: http://www.un.org/esa/socdev/iyop/iyopcal.htm

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The First Arab Regional Congress of Rehabilitation International and the Second Gulf Conference in Medical Rehabilitation

Safat, Kuwait

March 1999

Summary of Events

Dr. Adnan A. Al-Eidan, Director, Physical Medicine and Rehabilitation Hospital, PO Box 4070, 13041 Safat, Kuwait.

The First Arab Regional Congress of Rehabilitation International and the Second Gulf Conference in Medical Rehabilitation were held in Safat, Kuwait from 15-18 March 1999. During the Congress the importance of the International Year of Older Persons (IYOP) was specially emphasized in the following ways:

The emblem of the IYOP was exhibited in the conference proceedings and was printed in all the official correspondence.

Delegates from Arab Region.
One full day of the scientific proceedings was devoted to the care of the elderly in medical, social, and educational aspects, which was well attended. On that day plenary lectures were delivered. Dr.Alexander Siderenko of the UN about "International Year of Older Persons". Dr. Abdul Minham Ashoor (Egypt) and the president of ISAPA, Dr. Wojtek Chodzko-Zaiko (USA), spoke in detail about "International Initiatives to Promote Successful Aging".
In the medical sessions Parkinson’s disease, psychological aspects of rehabilitation of the elderly, osteoporosis, quality of life of the elderly, and physical activity in the elderly population were discussed.

Dr. Adnan Al-Eidan, Chairman of Organizing Committee, with international delegates.
In the social sessions the topic was on the elderly population in the Arab world. Many delegates from the Arab region actively participated.

A group of delegates visiting the exhibition.

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The 5^th World Congress on Physical Activity, Ageing and Sports

Orlando, Florida, USA

August 1999

Event Report

Dr. Bob Laventure, Physical Activity Programme, Health Education Authority, 30 Great Peter Street, London, England, SW1P 2HW; Tel: 0171 413 2005.

The following provides a summary of the key areas of interest that arose from my attendance at this event. Compiled as a result of a meeting of other UK delegates who attended the event, this report draws together the key messages relating to the promotion of physical activity among older people that were shared at the World Congress.

Introduction

The Congress was attended by more than 400 international delegates. Although North America was represented by a large number of delegates, there was considerable representation from Europe, the Far East and many developing countries. Delegates consisted of individuals from higher education and centres/institutes for ageing and exercise, exercise and fitness instructors, physical therapists, researchers and public health specialists.

The event was supported by:

Centre for the Study of Ageing
American Senior Fitness Association
United Nations Programme on Ageing
World Health Organization

The event consisted of:

4 keynote presentations, 13 separate symposia
41 oral presentations, 20 round table presentations
8 workshops, 8 (very) early morning practical workshops
60 poster presentations

Conference abstracts have been published in the Journal of Aging and Physical Activity, Vol 7, no 3, 1999.

The JAPA webpage is at: http://www.humankinetics.com/products/journals/journal.cfm?id=JAPA

Key areas that were addressed:

The promotion of successful ageing as a dynamic, optimistic and "to be welcomed" concept.
The largely ignored need for physical activity and exercise among the oldest old.
A well-rounded approach to physical activity and exercise promotion that draws from a variety of sciences, topics and perspectives including exercise physiology, psychology, bio-mechanics, geriatric sciences, nutrition and mental health.
The overwhelming evidence (i.e. qualitative and quantitative studies) that is now available to support the positive role of physical activity in enhancing the quality of life among older adults.
The need for multi-disciplinary intervention and research models.
The need to shift the focus away from disease prevention towards the maintenance of function, independence and mobility.
The significance of gender issues across the age span.
The importance of national coalitions and alliances reflecting collaboration.
Overcoming professional and public concerns concerning safety relating to
Assessment and screening
Levels of intensity for physical activity
Risk of injury/fatality
Design of programmes
The specific environmental determinants of physical activity and exercise participation among older people.
Accessible and consistent methods of assessing functional capacity.

1. Conference keynote sessions

Physical Activity, Ageing, and Health.

Steven Blair

A review and update of research related to physical activity, fitness, health and ageing, with a strong focus upon the relationship between physical activity, obesity and late onset Type II diabetes. Physical inactivity leads to insulin resistance syndrome and consequently can cause diabetes. Physical activity delays all cause mortality of people with Type II diabetes. Methodological problems have resulted in the significant underestimation of the impact of sedentary behaviour.

Eternally Wounded Women: Feminist Perspectives on Physical Activity and Ageing.

Patricia Vertinsky

An outline of the implications for an ageing society with reference to gender inequalities throughout the history of sport, exercise and physical activity. The male is perceived as the standard or norm, the female as inadequate and the implications of the perpetuation of this inequality should serve as an example to those who work with the aged. The marathon was used to exemplify the successful transition of female involvement from full exclusion to full involvement.

Public Policy Issues in Healthful Ageing.

Alexandre Kalache

An overview of the importance of health in both developed and developing countries to ensure that as individuals grow old they continue to contribute to their families, communities and the economy. It was emphasised that "the developed world became rich before it became old, the developing world will become old before it becomes rich".

Addressing the Physical Activity Needs of the Oldest Old.

Priscilla MacRae

A summary of current research on the oldest old and the extent to which we are addressing the health-related physical activity needs of this group. The oldest old, 85+ years, is the fastest growing group in the population. This is a heterogeneous group that has diverse needs. Most alarming is that people in nursing homes (likely to be over 85 years of age) may spend up to 80 – 90% of their time sitting or lying down (complete inactivity).

Priorities for the oldest old should include:

Maintenance/redevelopment of independence, mobility and function
Maintaining the ability to perform activities of daily living
Increasing (or preventing the loss of) muscle strength (power) and bone mineral density

Among the oldest old, well-researched interventions have been shown to:

improve postural hypotension
reduce pain and joint stiffness
improve sleep patterns
increase social contact
improve psychological health
relieve constipation

The Michael Pollock Memorial Symposium:

Implications for Health and Effective Functioning in Older Adults.

Per Olaf Astrand, Walter Frontera, Neil McCartney, and Steven Blair

The symposium addressed issues relating the relative benefits of cardiovascular and resistance training to ageing and health. There was a strong consensus that both training modalities will bring about similar broad health benefits (e.g. increases in social contact, well-being, quality of life, self efficacy and self esteem). There was also a consensus that programmes should offer a comprehensive or rounded view of physical activity for older adults consisting of aerobic activity, strength, flexibility and balance training.

The Assessment of Older People Prior to Exercise, the Value of the PAR-Q Assessment Tool.

Roy Shephard

A Michael Pollock Memorial Award presentation that examined the use and merits of the PAR-Q tool as a means of assessing the older person prior to participation in an exercise programme. In many cases, its use is unwarranted and leads to denying access to those who would most benefit from participation in a physical activity programme.

2. Conference symposia

The Determinants of Physical Activity in Older Adults.

Abby King, Sara Wilcox, Jack Rejeski, and Edward McAuley

In this session a panel of four researchers examined the motivating factors and other determinants contributing to physical activity participation among older adults. The research was triggered by the observed variations in exercise participation rates among various states in the US and countries in the EU. It was concluded that environmental and social factors are key areas to be identified and acted upon to increase and maintain physical activity participation.

67% of women and 80% of men prefer to exercise alone – this was true across ethnic groups. Although classes for older people are popular for those who participate, this represents a small proportion of the older adult population. The motivating factor for participation was found to be "to maintain good health". The experience of sweating and having an increased heart rate is a negative aspect for many people. Environmental factors within the neighbourhood that enhanced physical activity were the presence of hills, enjoyable scenery, and the presence of others who were exercising.

Assessing Functional Capacity in Independent Older Adults.

Roberta Rikli, M. Elaine Cress, C. Jessie Jones, Joan Bassey

Of those in the US who are over 70 years of age, 25% are either physically dependent or physically frail, 70% are independent and only 5% are physically fit. The loss of functional capacity is about 1% per year in the fit and active but 3% per year among those who are sedentary.

The Fullerton Functional Fitness Tests, a series of functional tests used to assess strength, balance, flexibility and aerobic power, was presented. These tests have no ceiling effects and give scores for both independent and very dependent subjects. Details of these tests can be found in recent issues of the Journal of Aging and Physical Activity.

Interdisciplinary Research Models in Physical Activity and Ageing.

Waneen Spirduso, Leonard Poon, Miriam Morey, and Wojtek Chodzko-Zajko

The symposium outlined the need for more imaginative research models to support physical activity interventions. Current practice points towards the use of inter, multi and cross disciplinary approaches which could be achieved by "virtual" research teams. Exemplar models highlighted the potential role of exercise physiologists and psychologists working alongside bio-mechanics, nutritionists, pharmacologists, gerontologists, and even speech scientists. These multi-disciplinary research teams reflect the need for multi-agency and multi-skilled intervention strategies.

Longitudinal Research Models in Physical Activity and Ageing.

Eino Heikkinen, Taina Rananen, Suzanne Leveille, Stig Berg, and Scott Hofer

This symposium highlighted work from the Finnish Evergreen Study and the National Institute on Ageing 30 year longitudinal trial on obesity, physical activity and function. Within these trials, those who had died prior to follow up were more likely to have had lower levels of physically active, strength, walking speed, cognitive performance and functional ability, and have had greater body fat, than those who were still alive at the 5 year follow up.

The Honolulu Heart Study showed that at 27 year follow up, those who had died had lower handgrip strength and were less active than those who survived. Researchers considered a lower handgrip strength of less than 2.1 kg to be a threshold value for survival. A 1% loss of strength is normal in old age but a steeper decline of strength (>1.5%) is indicative of earlier mortality.

Linking Research with Clinical Practice and Public Policy.

Michael Sagiv, Yael Netz, and Makoto Chogahara

Researchers from the disciplines of exercise physiology, social gerontology and clinical practice examined the extent to which public policy initiatives are consistent with current research findings in physical activity and ageing. The symposium also addressed how research should assist and facilitate public policy rather than drive it.

Muscular Fitness for Bone Health and Independent Lifestyle.

Joan Bassey, Mim Nelson, Wendy Kohrt, and Debra Rose

Panelists presented a framework that examined how low levels of physical activity lead to poor muscle strength which leads to poor balance, which leads to falls and low bone strength, which leads to osteoporotic fracture (a downward spiral).

The impact of exercise has been under-estimated as a result of weaknesses in measurement techniques. There was some debate regarding the role of estrogen replacement relative to protection from osteoporosis and Alzheimer’s Disease, the increased risk of cancer and the accumulation of stomach fat in women.

Specific contributions relating to balance and falls outlined the importance of physical activity within a multi-dimensional intervention. Early interventions will produce better outcomes.

There is now good evidence that "bed-rest" for a slipped disc should be avoided. Losses up to 1% of total bone density every week are possible while lying flat. Also, 20-30% of aerobic capacity and up to 30% of muscle strength can be lost within the first few weeks of best rest. Hormone replacement therapy can not only increase bone density but also improve muscle strength (up to 13% in one year).

Motor Coordination and Ageing.

Hartmut Baumann, Ellen Freiberger, and Yael Netz

This symposium examined the potential to reduce the age-related decline in motor skills and coordination. This is a relatively new area of research and practice in the aged, previously having been largely devoted to skill development and learning among young people. Given the emphasis placed on well-rounded approaches to movement among older people, there is the potential for significant new work in this area.

Qualitative Approaches to Physical Activity and Ageing Research.

Sandra O’Brien Cousins, Mary Ann Kluge, Makoto Chogahara, Ann Clarke, David Langley, and Patricia Vertinsky

Those involved in this symposium presented qualitative approaches used to study older persons including interviews, narratives, biographical case studies, childhood recollection, open-ended surveys, and discussion groups. The information collected from these alternative approaches provide additional insight regarding physical activity and ageing.

Healthy Ageing in Developing Countries.

Vinod Kumar, Alexandre Kalache, Andrea Prates, Adnan El-Edan, and Jin Yan

Vinod Kumar shared his perspective on healthy ageing and physical activity in the Indian subcontinent. He emphasised the heterogeneity of India’s older people and highlighted the fact that 75% of them live in villages. Although sport, recreation and exercise are uncommon, the necessity of performing household chores means that many older people remain active. However, this is a result of their poverty rather than a deliberate choice. Alexandre Kalache discussed the World Health Organization’s concept on active ageing. Andra Prates, representing Latin America, described developments in Cuba where older people themselves had set up community groups which focussed on health. Adnan El-Edan presented perspectives on healthful ageing in Arab countries using his experience and knowledge of Kuwait. He described how Kuwait had rejected the Western model of institutional care for older people – they had tried this but found that it didn’t work and since the 1980s have changed their strategy. Their approach is social-cultural and involves providing services for older people in their own homes using multi-disciplinary teams. They are also developing day care centres for older people that include physical activity. Jin Yan discussed issues relating to physical activity for seniors in China.

Physical Activity for Older Persons with Physical Impairment.

Crt Marincek, Helena Burger, Ellen Binder, and Rueben Eldar

This symposium examined the needs of older persons with physical and other impairments including dementia and neurological disorders. Several programs for impaired seniors were presented. Functional testing of those with impairments was also addressed.

Approaches to Physical Activity and Ageing Research.

Kiyoji Tanaka, Sho Ondera, and Eitaro Nakamura

This symposium presented findings regarding ageing and physical activity among the populations of Japan and Korea. The results of several studies were discussed which exemplified some similarities but many differences regarding functional fitness between older persons in these two countries. The measurement of biological vigor was also introduced.

Active Ageing in the New Millennium: Translating Research into Programming, a Canadian Initiative.

Nancy Ecclestone, Don Paterson, Anita Myers, Penny Williams, and Clara Fitzgerald

Programs developed by The Centre for Activity and Ageing were highlighted. The approaches used to evaluate the effectiveness of these programs were given much attention. Efforts to apply research findings to community programmes were emphasised by the presenters.

Physical and Mental Training: Implications for Cognitive Functioning in Old Age.

Arthur Kramer, Anders Ericsson, and Arthur Fisk

The presenters in this symposium focused on enhancing skill performance in the elderly. The influence of experience and training on skill acquisition was emphasised. The effects of aerobic fitness on cognitive function were discussed.

3. Other themes to emerge as a result of presentations from round table, oral and poster presentations.

Muscle strength and power

There was a strong consensus that, in relation to the prevention of falls and accidents among older people, the development of muscle power (the ability to produce strength quickly) was of prime importance. In effect this should supplement some of the thinking relating to the development of strength among older adults.

Gender Issues

Low levels of physical activity, exercise and sports participation among younger women will have a major impact upon their activity levels as older women. The demography of ageing also points towards a significant gender imbalance in the ageing population.

Environmental determinants of physical activity

It has become increasingly apparent that physical activity that can be incorporated naturally throughout a person’s day may provide the most effective means for increasing physical activity levels of the population at large. Yet little information is available concerning the types of environmental and lifestyle interventions appropriate for older people. There is a need for a better understanding of how and where older adults spend time as a means of defining situations where appropriate interventions could be targeted. Issues such as fears of attack, personal safety and security at home and in the community require further attention.

Motivation and older people

Amongst the oldest old, motivation to become involved in a programme of physical activity relates to personal targets set by older people. Personal belief systems among older people relate to goals concerning functional independence and independent living (e.g. to be able to walk to a bus for a shopping trip, to be able to get in and out of a wheelchair, to be able to get in and out of a bath). There may be a need to re-visit the rationale for physical activity promotion with older adults and make a clearer distinction between the benefits to individuals and the benefits to society.

Functional assessment tools

There is now a multiplicity of functional assessment tools available, including physical, psycho-social and motor development measures. For those relatively new to this area, the number and range may appear to be bewildering. Many of these tools were developed in North America and appear to have been developed with a concern for commercial opportunities and the need for standards among national testing programmes. There is a need to develop tests to which older people can relate (e.g. getting up off the floor rather than Watts of power produced).

Age related decline in function

The rate of functional decline among older adults and the potential to slow or even reverse declines through physical activity related interventions was of interest:

Loss of strength begins as early as 30 years of age, declines 10 – 20% per decade
Loss of power begins at 35-40 years of age, declines 30 – 40% per decade
Loss of balance begins around 40 years of age, declines 10- 20% per decade
Those who are fit and active lose functional ability at half the rate of those who are sedentary.

Negative influence of GP and health professionals

Previously identified in the HEA qualitative research publication "Physical Activity at Our Age", the role of the GP and other health professionals in offering physical activity recommendations and guidance is significant. However there is substantial evidence that the negative messages and concerns expressed (intentionally or unintentionally) by such professionals far outweigh other positive influences upon OP (e.g. from family and friends).

Strength recommendations

Significant strength gains among older people can be achieved, even among frail older people through the use of relatively light (and consequently safe) weights using 1 set of 8-10 repetitions of each exercise. Increased sets and repetitions do not necessarily bring about increased gains. There needs to be an increase in the weight lifted and the increases should be progressive. In the practical situation, older people prefer working with elastic bands than weights. Although bands may only bring about a limited increase in strength, they may provide significant increases in functional ability.

Maintenance of general activity patterns and the importance of motor coordination

Cardiovascular disease prevention and muscular strength improvement remain important components of work relating to older people. However, activities that encourage motor development and coordination (and therefore improved balance and reaction time) also form an important part of activity recommendations. There are significant implications for the prevention of falls and fractures, but also for the maintenance of activities of daily living.

Needs of the oldest old

Members of this age group are likely to be female, without a partner, depressed, institutionalised, and to make high demands on health care services. Frailty is described as a reduced state of physical reserves and a loss of ability to live independently. This syndrome is caused by biological ageing, chronic disease, malnutrition (related to poverty) and physical inactivity.

The activity levels of nursing home residents (calculated by energy expenditure) are equivalent to 34 k/cals per day above resting metabolic rate among restrained adults and 47 k/cals among unrestrained adults. Studies show that older people in nursing homes spend 80 – 90% of their time seated or lying down.

The use of chronological age as a predictor of dependence is not appropriate. Many 80 year olds are functionally dependent but those who are fit, active and relative healthy may be independent until they die.

Launch of the International Society of Aging and Physical Activity (ISAPA)

The conference featured the public launch of the International Society for Aging and Physical Activity, an independent, professional society designed to promote physical activity, exercise and fitness for older persons though international initiatives in research, clinical practice and public policy. The society also launched its website with an impressive display of international and national links, bulletin boards and information sources.

Details of ISAPA can be accessed through its website at: http://www.isapa.org/

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The First International Conference on Aging

Tehran, Iran

October 1999

Declaration

"The First International Conference on Aging- Tehran, Iran" was held from October 19 to 21, 1999 under the auspices of Her Excellency Mrs. Zohreh Sadeghi, the esteemed wife of the President of the Islamic Republic of Iran and the Conference Honorary Chair. The conference was sponsored by the Ladies Charitable Society (LCS) affiliated with the Kahrizak Home for the Disabled and the Elderly (KHDE) and in consultative service with ECOSOC. In this endeavor, the LCS enjoyed the support and cooperation of several Iranian and international organizations as well as other benevolent individuals and groups. The conference was attended by Iranian and international experts and the representatives of international organizations including NGO Consultative Committee on Aging of the UN, the UN office in Iran, UN Development Programme, and UN Population Fund.

This conference was convened to honour "The International Year of Older Persons, 1999" and for the purpose of promoting human principles and exploring new ways of better understanding the elderly and the aging phenomenon. In this conference 96 papers were presented during 6 plenary and 8 specialized sessions on the following themes:

Social issues of aging
Medical issues of aging
Psychological and emotional issues of aging
Environmental issues of aging
Nutrition and physical activity in the elderly

The following are the views and conclusions as reached by this conference:

1. The conference commends the humanitarian efforts of the UN and considers such gatherings a firm step forward in forging the bonds among diverse cultures and promoting "the dialogue of civilizations".

2. Experts, scientists, and researchers from all over the world who gather with the objective of finding effectual solutions to mitigate human suffering, reject violence and hostility, and to strengthen international solidarity is an efficient measure in bringing human generations together.

3. We call on international organizations, the UN in particular, to urge their member states by means of resolutions and practical measures to allocate part of their military budgets to forums such as this conference. This would provide the beneficial exchange of information and further development of collective world knowledge.

4. Considering the inevitable aging of the world population in the years ahead, which will particularly affect developing nations, we call on relevant UN institutions to establish "Regional Centers for Population Aging Studies" and to provide assistance for founding the first "Regional Center of Gerontology" in Iran. We recommend that this project be implemented by LCS affiliated with KHDE, which is considered the largest care center for the disabled and the elderly in Iran.

5. The conference calls on the WHO and the Coordinating Committee of "The International Year of Older Persons, 1999" to provide assistance in opening departments of geriatrics in the medical schools of countries with large populations, including Iran; and to accord priority to the Elderly Rehabilitation Project presented at this conference.

6. The conference entreats governments to include in their national development plans projects for the improvement of the status of the elderly and to implement these projects in cooperation with NGOs, organizations of the affairs of the retired, and community committees.

7. Considering that parliaments are the dynamic nucleus of national and popular decision making, we propose the establishment of "The Aging Committee" within these legislative bodies. In these committees, representatives of the people shall be able to pursue the aging issues and the welfare of the elderly in a more substantial and persistent manner.

8. Establishment of the "High Council on Aging" is essential for coordination of government and community activities. This council should be under the direction of the highest executive authority of the country.

9. The conference calls on countries in the region to offer special public training programmes for entering old age at individual, family, and community levels. These programmes serve to converge the perspectives of different segments of the population and to create an environment replete with intergenerational understanding.

10. Governments should provide opportunities for active participation of older persons in social, economic, and cultural affairs. Part-time and flexible employment opportunities should also be created for this segment of the population. Implementation of such policies shall enable the elderly to continue active lives within the family and society and to elude isolation and depression.

11. In formal education syllabi there should be included subjects on preparation for able aging from economic, social, physical, and psychological perspectives. These programmes should be initiated at primary levels and extended to higher levels as required.

12. The governments are requested to provide free special and emergency care for the needy elderly, particularly long term care, rehabilitation, and treatment by use of government subsidies within the framework of "Special Insurance Schemes for the Elderly".

13. Considering the acute need of the elderly for healthy leisure time, establishment and expansion of day care centers for the elderly should be accorded high priority. In addition to healthy leisure facilities, these centers should provide first aid and general education. Municipal authorities and community-based organizations can help establish such centers in public parks or other easily accessible areas with pleasant climate.

14. The experience of the Islamic Republic of Iran in the context of The Ladies Charitable Society has testified that community participation and contributions of benefactors are substantial and secure means for meeting the needs of the disabled and the elderly, including their care at nursing homes. What those responsible for such institutions require most, in order to keep on their noble cause unfailingly, is people's reliance and support.

The conference calls on international organizations and participants from abroad to encourage the formation of such dedicated volunteer groups in other countries by introducing the activities of LCS and paving the path for their presence in relevant international forums.

The conference expresses its deep appreciation to the Islamic Republic of Iran and LCS for their generous hospitality and remarkable accomplishments in convening the conference.

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International Gerontology and Geriatrics Conference

Pune, India

December 1999

Resume

Dr. Sunita Kulkarni and Dr. S. M. Karandikar, Centre for Gerontology and Elderly Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune 411 043, India.

The conference was organized as part of the celebrations recognizing 1999 as the International Year of Older Persons. Like many other developing countries, India is experiencing a growth surge in the elderly population. Many of the problems faced by these populations are culture specific and need special attention. It was the purpose of this conference to address many of these issues.

Medical College of Bharati Vidyapeeth Deemed University, Pune and the Association of Senior Citizens' Organizations of Pune hosted the conference held from 3-5 December 1999. The Bharati Vidyapeeth Deemed University has a Medical College for modern medicine, Ayurveda College for traditional systems of medicine, and colleges for Homeopathy, Nursing, and Dentistry. The entire faculty and staff of the university participated in the conference. The conference was also attended by participants from various parts of India and from abroad. In addition to medical teachers and health professionals, experts and specialists in various disciplines (social sciences, engineering, economics, law, etc.) contributed to the deliberations and discussions. An important feature of the conference was the large delegation of senior citizens in attendance who belong to many senior clubs.

The four scientific sessions of the conference included plenary sessions on four themes:

Theme 1: Age-related disorders and disabilities.

Indian scenarios of various diseases in the elderly were presented by one of the senior consultants in geriatric medicine. Health related problems, their prevention and management in surgical, orthopedics, and dental specialties were addressed. Psychological problems of cancer patients, disorders of digestion, and diseases transmitted through pet animals in this population received attention. Uses of alternative medicine/therapies such as yoga, homoeopathy, and acupuncture were also discussed.

Theme 2: Assistive technologies for better quality of life.

Dr. Karandikar highlighted advances in health care technologies including the development of smart medical, social, and environmental sensors, tele-health care, and tele-medicine. A "New Model of Aging Well" was presented. This model involves the use of various technologies for disabilities and interventions. Supportive measures for ocular and auricle problems were discussed. Also receiving emphasis was the use of yoga, breathing exercises, and meditation to improve the quality of life.

Theme 3: Special needs of housing for the elderly.

Housing needs of the elderly, universal design of houses, participatory management, and layout of houses were discussed. A model of ideal home architecture and design was presented. Life Insurance Corporation authorities regretted a lack of loan facilities for housing for the elderly, but suggested some other measures for financial assistance. The difference between 'Shelter' and 'Home' was explained. Dr. Vanessa Burholt from the University of Wales, Bangor, UK reported on the pressure of migration in rural people of Wales, UK wherein friendly networks and love for the home served as main factors in decision making.

Theme 4: Economics of the elderly.

An overview of economics of aging in India was presented by one of the economists from the Applied Research & Training Council for Social Development, a governmental organization. Socioeconomic problems in the elderly were presented. Needs for social security from the government and the creation of a caring society were emphasized. Professor Clare Wenger from the University of Wales, Bangor, UK discussed family economics and the inter-relationships of family networks in the UK.

There were many oral and poster presentations at the scientific sessions. Some of them deserve special mention. Policy implications of Australia's ageing population were presented by Dr. Ashok Tulpule, eminent economist from Australia. He emphasized income support and health services and anticipated difficulties with these matters. In the poster sessions, "Pharmacists' involvement in geriatrics", "Contented ageing in women", and "The right to die-a pilot survey" triggered interest and discussions.

Messages carried from the conference:

Prevention is better than cure.
Surgical phobias need to be removed.
Preparation for old age should start from middle age for provision of housing and finances.
The need for government social security is acutely felt as at present very meagre assistance is given, and that too varies from state to state. Many people feel that it needs to be replaced by self-financing plans to make it economically sustainable.
Efforts towards creating a caring society were emphasized.

Exhibition: For the benefit of senior citizens and the general public, an exhibition presenting various aspects of ageing was organized. The participation of many industrial, governmental, and non-governmental agencies made the exhibition very educative and practical for everyone. The exhibition covered biological aspects of ageing as well as various disorders and disabilities associated with ageing. It also addressed measures to overcome ageing-related disorders and disabilities with the use of numerous aids, appliances, and assistive technologies which could help achieve better quality of life for the old, frail, and other individuals with varying degrees of disabilities. All the colleges and their departments contributed their knowledge, skills, and creativity to produce an outstanding exhibition.

A visit to Cipla Palliative Care Centre, a facility of high quality that was created by one of the leading pharmaceutical companies of India as a social obligation in Pune, was organized for all delegates. This centre imparts training to the relatives and care-givers of terminally ill cancer patients regarding proper care given with love and tenderness to the sufferers so as to make life bearable.

In conclusion, the conference was a great event and provided many benefits for the professionals and senior citizens in attendance. The information and ideas exchanged at this conference will help those in attendance from India and other countries to better understand the needs of older persons within different cultures and to better provide the services that they require.

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