BY EVE JACOBS
The next time you say, "How are you?" to a baby boomer, the answer will probably be "Fine."
But chances are there's more on their minds than you might have time to hear. Many are chronically tired and achy, fearful of violence and cancer, worried about increasing forgetfulness and balancing the care of children and parents, as well as facing the possible loss of a job. Stress is something they wrestle with on a daily basis.
That's what we discovered when we surveyed University employees, age 34 to 50, on their top health concerns. Of 250 surveys distributed, 136 were returned. Looking at our boomers as a microcosm of American mid-lifers, you may be intrigued by what's really on their minds and how the experts responded.
|The Top 10 Health Concerns|
& the Percent of Worried UMDNJ Boomers
|Chronic daytime tiredness||54%|
|Stress as a constant factor||52%|
|Feel threatened by violence||49%|
|Sedentary job/ trouble finding time to exercise||45%|
|Worried about getting cancer||45%|
|Concern about memory decline||43%|
|Achy back and/or joints||40%|
|Ageism in the workplace||32%|
|The Next Five|
|Workplace health hazards|
|Loss of faith in traditional medicine and interest in alternatives|
|Beginning to act like one's parents|
|Difficulty coping with the daily grind|
|Current effectiveness of their childhood vaccinations|
|Two That Also Ranked High|
|Taking care of young children and aging parents|
|Anxiety at the thought of turning 50|
Stressed and Tired All the Time
Who would have guessed it? More than half the respondents said stress and fatigue are their number one health concerns. And these top two got almost an equal number of votes.
What is stress, how can we manage it and how does it relate to daytime tiredness?
The term stress was taken from a metal-working model, according to Steven Schleifer, MD, chair of psychiatry at UMDNJ-New Jersey Medical School, and is used to refer to an external stimulus that puts strain on an object, as in "stress and strain."
Metal can take stress and is bendable, but will eventually reach a breaking point. So, too, a cell, a person, a family and a society are thought to have a steady state where they can cope, be active, stimulated and relatively comfortable.
"Until very recently, stress was perceived as something bad that happened - an auto accident, the loss of a spouse, an earthquake - that would push someone beyond the comfort zone," explains Schleifer. "Now we know it's not that simple. Not everyone reacts similarly to the same event."
He says that Post Traumatic Stress Syndrome (PTSS), for instance, was thought to be an inevitability of certain combat, or other extraordinary situations, but is no longer considered a necessary reaction. "Only some people exposed to extreme stressors will react in this way."
Experts now say we have to take into account the individual's personality, his or her ability to cope, and also what physical and mental state the person is in. These are very variable, says Schleifer.
Take, for example, an intensive care nurse who may be able to stay awake and alert through 20 hours on the job if there's a snowstorm that keeps some co-workers home.
But now suppose the individual has been awake for 16 hours prior to this unusual demand. Add to this, assigning her a task she doesn't know how to do. And to top it off, the snow doesn't look like it's going to let up and so she may be needed on the unit for another eight hours.
"People are adaptable within a certain range, but there's a point when they can no longer cope," says the psychiatrist.
Look at the current work environment in many big companies. "Downsizing" may mean that each person's work load increases by 35 percent. That's doable for most people, even though it may be fatiguing.
"But volume is not necessarily the issue," says Schleifer. "Suppose you need to do twice the usual volume of work on Monday through Thursday, but if you accomplish it, you can leave early on Friday. You'll probably do fine because you know what's expected, have a sense of control and you know what you can do to relieve the extra pressure.
"Now imagine that on days one, two and three, you get double your usual volume of work. On day four, you expect it to let up but it doesn't. On day five, the same situation continues. No one communicates with you about what's going on, and you can't predict what's going to happen the next day - or next week. You have no control over the situation. Most people will find this stressful."
Your work performance and emotional state may start to suffer, then your physical health. Add to that the feeling that no matter how much good work you do, no matter how many extra hours you good-naturedly put in, when push comes to shove, you might get shoved out anyway.
"Feelings of powerlessness have a proven negative impact on health," Schleifer states.
In an experiment where it was found that rodents subjected to stress had an increased rate of tumor growth, two groups of animals were observed. One group was stressed but had the capability to stop it, the other could not. "The animals who had some control looked as if they were not stressed at all," he says. "The ones with no control continued forming tumors."
What physiological changes can stress produce in humans? According to the stress expert, it can lead to changes in heart function, blood pressure, intestinal activity, hormone levels and immune function, to name just a few. "There's no end to the variety of effects stress can have," he says, "and we can't predict what will affect a particular person or in what way."
Schleifer says that an individual suffering major stress at work may take it out on his or her significant other, who may, in turn, cope with the situation for a while, but eventually get worn down. "The family support system can break down because it's no longer keeping people in balance," he says.
So, in a world that's changing so rapidly and in so many ways, what exactly can you do to keep the lid on stress?
"Start with an assessment of what the stress is," advises the psychiatrist. "Sometimes it's not obvious. Ask yourself: 'What is knocking me off balance? What's really bothering me? Why don't I feel in control?' You might think it's your work situation when it's really your home life.
"Then ask yourself: How am I trying to cope? Is it helpful or not? How can I do better? If you can't answer these questions yourself, ask for help from a good friend or a member of the clergy."
Denial, he says, is sometimes a very effective coping mechanism if not taken too far. Preliminary studies with cancer patients have shown that those who use denial - who won't even say the word cancer but who still take prescribed treatments - fare better than those who stoically accept their plight. And since anxiety often goes hand-in-hand with stress, he says learning relaxation techniques will often help, but can't replace an assessment.
What should you do if everything you've tried is backfiring, or if you really don't understand what's going on?
"Basically, it's not so different from dealing with a leaky pipe. If you can't fix the situation with the resources at hand, then it's time to call in a professional," Schleifer concludes.
You Can't Burn the Candle at Both Ends, Baby
The primary reason most of us are so weary is that we chronically deprive ourselves of sleep, says Raymond Rosen, PhD, academic director of UMDNJ-Robert Wood Johnson Medical School's Sleep Disorders Center. "The majority of adults in our society sleep one or more hours less each night than they physically need," he explains.
Why would we do such a thing? "Many people say they can't fit everything they need to do into a 16-hour day. Some feel that being productive or ambitious means denying themselves rest time. It seems to be macho to survive on five or six hours sleep each night," says Rosen, who is also a professor of psychiatry at the school. "Our society has a negative bias toward sleep and it takes its toll."
And if you believe the common myth that as we get older, we need less sleep, you've been duped. "You lose the ability but not the need for sleep," he says. "You need at least as much, maybe more."
Of those who realize its necessity and carve out the requisite eight hours for restorative zzz's, about one third either cannot get to sleep or cannot stay asleep. Rosen says insomnia is like fever - a warning sign that something is not right.
It can be as simple as drinking too much coffee, watching TV in the bedroom or failing to establish regular sleep and wake times. Alcohol, drugs, pain, apnea, or other breathing problems, and muscle jerks and twitches can all interrupt sleep.
But when someone with insomnia seeks his help, Rosen says his first question is always: Are you feeling sad, anxious, depressed?
"Sleeplessness is a major symptom of depression," he says.
Schleifer concurs. Depression can be precipitated by stress in someone who is predisposed, he says. Other symptoms may include a decline in energy and motivation and a preponderance of negative thoughts and feelings. "Medication may be needed to reverse the situation," he advises.
Daytime sleepiness may be linked to stress in other ways. "For some people under stress, sleep is a way of coping, a time out," he explains. "They may sleep far more than their usual amount."
For others, anxiety causes tossing and turning at night, leading to daytime wilting. Stress involving the family and home is also likely to hinder sweet dreams.
And those who turn to alcohol or drugs for stress relief "beyond narrowly prescribed boundaries" are treading dangerous waters, says Schleifer, which will include night-time sleeplessness and daytime fatigue.
"There are many causes for daytime tiredness," concludes Rosen, "and they are all important. If you don't feel refreshed in the morning, if you feel you're not reaching the depth of sleep that you need, if your fatigue is having an impact on your daytime function, first try to identify the cause. You may be able to remedy it yourself."
Then, if simple measures fail and the pipes are still leaking, the experts recommend you set up a consult with professionals.
It's a Mad, Mad, Mad, Mad World
Stress and fatigue are predictable concerns for baby boomers, but who would guess that fear of violence is so much a part of our psyches?
"It's terrible to be a victim of violence. The effects can be permanent," comments Steven Simring, MD, clinical associate professor of psychiatry at New Jersey Medical School. "But there's a difference between violence and the perception of violence."
He says that most of those surveyed probably have not been hit by brutality on the streets, the highways or in their homes, and are actually worried about something that will never happen to them. The big question, of course, is: Why so much worry?
"We all see a constant barrage of violent images transmitted by the media," says the psychiatrist. "As a result, some people become hyperalert and hyper-responsive, acting as if this turbulence is always just a moment away." He explains that even those who are not literally victims can overreact to the cues, suffering periodically from broken sleep, nightmares and nervousness, or even rapid breathing and heartbeat in response to loud noises.
Simring theorizes that some of the concern may be based on a sense that the environment of certain cities seems disorderly. "Many times the police say they can not deal with the small stuff - graffiti, broken windows, damaged cars - because there's murder and rape out there."
He says,"Everyone gets the sense that the best cops can do is deal with the worst, and they become acclimatized to a sense of disorder."
Simring points to the book, "Fixing Broken Windows," which proposes that allowing minor offenders to get off encourages disrespect of the law, while punishing them - even those who just break windows - gives the message that lawlessness is not tolerated.
"People who live or work in a city need to feel that there is respect for the law and that a sense of order prevails," says the psychiatrist.
Simring also suggests a personal safety defense course for those who feel threatened by violence. This is very different from judo or karate, which are martial arts, he says.
"You won't necessarily remember the physical techniques you practiced using on a pretend mugger," he explains, "but you will remember the psychological techniques. Many victims are just too polite. You walk away from a good personal defense course with an attitude of empowerment."
Of Dinosaurs and Other Extinct Creatures
So you're turning 50 and facing the job market once again. You have skills and experience, you look good, you feel good. You're at least 10 times wiser than when you landed your first big job 20 years ago. Why aren't you getting any offers?
According to Simring, ageism is and always has been part of our culture. He says that because of economic hard times, the bias against older people is no longer swept under the rug the way it once was.
"It used to be unthinkable to let people go 10 years before retirement even though you might have preferred a younger employee," he comments. "When there's not enough to go around, the real attitudes surface."
He points out that of the generation turning 50, most men have been in the job market for at least 25 years. "They're at the top of the salary range, they have expensive benefits packages, but they may not be hustling quite as much as they once did," he observes. "For many professional women in this age group, the situation is somewhat different. They came into the job market later - around age 35 - and are just getting into high gear. They're not yet being paid top dollar and are still quite ambitious and enthusiastic."
Simring suggests that everybody in their 30s and 40s - men and women - really think about what they would do without their job. "Wrestle with it at 35 while you're still employed," he suggests. "Start preparing yourself mentally for what is probably inevitable. Being heart and soul for the corporation doesn't work anymore. The issue is no longer how you will spend your retirement."
The psychiatrist counsels: "Don't just sit there and worry. Find a niche - one in which age and wisdom are assets. Do something where grey hairs will count for you. Get additional training and skills to make yourself marketable. Work for the company, but don't let yourself be owned."
Above all else, don't buck technology, he advises. "Don't be the one who says, 'I've been successful for 30 years without computers. Who needs them now?' That's like bragging about illiteracy."
Simring also warns against becoming a sour, grumpy old man or woman, harping on past glories, or being someone who spouts embarrassing, outmoded ideas.
"Keep current in both substance and attitude. You can't avoid getting old," he concludes, "but you can avoid becoming a dinosaur."
If you're a baby boomer in your 40s with a sense that your memory might be slipping, the experts say you're not imagining things.
"Yes, it's happening," says John DeLuca, PhD, associate professor of physical medicine and rehabilitation at New Jersey Medical School, "and that's normal. Memory decline often begins in your 20s."
So when you reach 48, what can you expect? According to the memory expert, most 48-year-olds who express worry about forgetfulness are usually saying something quite different. Even when they make themselves the butt of jokes and funny stories, he says they're really asking: Am I getting Alzheimer's?
If memory loss is starting to adversely affect your family life and happiness, if you have difficulty doing basic tasks, if your job performance is suffering, then worry, he advises. "But one of the key signs of early Alzheimer's is that those affected are rarely aware of the problem. The early signs are usually recognized by the family, not by the individual."
So, while most of us can scratch Alzheimer's off our list of top 10 health worries, what the heck is going on when we can't remember the title of that great mystery book we finished just two days ago or the name of that wonderful restaurant in Manhattan where we ate last weekend?
The word memory, which connotes the ability to retrieve information, is used by many people to mean cognitive performance in general, says DeLuca, who is director of neuroscience research at Kessler Institute for Rehabilitation. He goes on to explain that it's the speed and efficiency of information processing, not memory, that's often touched by aging. He says when individuals complain about memory problems they often tack on statements like: "It takes me a much longer period of time to do the same things I did 10 years ago," or "I used to pride myself on doing three things at once at work, but I can't do that any more."
A child's memory is far superior to an adult's, he states. "Think of what kids have to learn - language, motor skills, everything - in their first few years of life. An adult would probably not be able to do it."
There's great variability as to when the decline in what we call memory is first noticeable. "For some, it's in their late 30s. For others, it's not until their 50s," says the neuroscience researcher. "But on average, people will notice that their memory is not quite what it used to be sometime in their 40s."
Memory is a very complex construct, he explains, but it can be broken down into three basic processes: the acquisition or encoding of information; the storage or consolidation of data; and the retrieval of that material.
"Research has found that the breakdown is very often in the acquisition of information," he explains. If you didn't acquire it, you can't remember it. On the other hand, if you got the data and stored it, then generally you'll be able to retrieve it."
It's normal to write lists, he says, and it's even normal to forget you wrote the list. It's quite okay to wrap a rubber band or tie a ribbon around your finger to remind yourself about the list in your pocket, he counsels. You might also be relieved to know that intelligence - broadly defined as the ability to think analytically - doesn't begin to decline until much later.
DeLuca and Benjamin Natelson, MD, professor of neuroscience at the school, have begun to investigate the specific nature of impaired memory in multiple sclerosis, stroke, amnesia, chronic fatigue, and Gulf War syndromes and trauma. The inability to concentrate and difficulty in remembering are major complaints of those affected by these varied disorders.
"But most boomers - like myself - should just accept the natural process of aging and use whatever tools seem to work," DeLuca concludes.
"And please refresh my memory - what magazine did you say you're writing this article for?"
Where Do We Go from Here?
There's no quick fix for mid-life concerns, but getting a perspective on one's woes can certainly lighten the load.
Jacob Lindenthal, PhD, professor of psychiatry at New Jersey Medical School, points out that the majority of HealthState surveys were filled out in the week following the elections, when some respondents may have been feeling slightly more down than usual. It's also the time when the weather turns cold and daylight saving time departs, a reminder that the hours of light are diminishing and winter is imminent. People tend to feel more tired and duller than at other times of the year, he says.
Lindenthal also reminds us that we're tired and stressed because there's a lot of work to get done, the economy is less predictable than ever before, and that this is a "time of intense moral confusion - such as we witnessed during the O.J. trial."
The constant bombardment by TVs and computers, telephones that go wherever we go, beepers that call us from our reveries, and e-mail that must be answered quickly is also fatiguing. And then we're flooded with advertisements for exercise devices, soporifics, analgesics and other over-the-counter drugs that are supposed to de-stress us and make us happy, he says.
"But living is stress," he comments. "It's what keeps us going. It's only a problem when it's causing distress."
Lindenthal suggests that many boomers may be distressed because they don't realize they are no longer 20. "Maybe they're exhausted because they've taken on too much work or too many activities and should be slowing down a bit. Growing older means you get more tired," he says.
Violence, he states, is a real concern, not a fantasy. "We're constantly reminded by TV of what goes on inand out of urban areas. Also, as people get older, they generally get weaker and more fearful of violence. We all worry about teenagers who are drugged - whose judgment may be impaired."
About ageism in the workplace, he says it's a fact of life that your age will count against you when you're looking for a job.
"But each age has its pleasures and its pains," Lindenthal states. "First know your legal rights. Then ask yourself, 'What are my strengths? What qualities and skills have I acquired over the years?' Look for a good fit between your hopes and beliefs, your age - that will march inexorably on - and your next position.
"We can become obsessed with freezing ourselves at certain ages," he concludes. "Above all else, cultivate the ability to leave certain things behind gracefully and move on."
Note: Since this article was getting longer than we felt any boomer had the time or mental fortitude to handle, we concentrated on the mental health concerns and will address some of the other major worries in our spring issue.