With the birth of the 20 millionth person on Taiwan, the population problem has suddenly become the hottest social topic. At the same time, aging has already replaced population growth as the immediate concern to be faced.

Do you know--according to statistics of the Executive Yuan, at the end of 1987, the number of elderly (over 65) in the Taiwan area reached 1,083,000, accounting for 5.4% of the population. Using the current figure of each couple having on average 1.7 children, and the average life expectancy high (currently for men it is 71.09 years, and 76.31 for women), it is estimated that in the year 2,000 the elderly will reach 8.4% of the population, formally bringing the ROC into the ranks of the "elderly nations."

This proportion is still not startling. Take the developed nations--in Sweden the elderly are 18% of the total, have surpassed 15% in the U.K. and Germany, and in Japan, with the longest average life expectancy, they are 11%.

A high proportion of the elderly is something a country can be proud of. The UN uses "elderly population has reached 8% of total population" as an important indicator of a developed nation. This is because such a figure can be reached only in those nations where health care, environmental protection, the economy, and even human rights are highly developed. Using this standard, Taiwan has a lot of catching up to do.

Some call the elderly the "masters" of the future, "and this isn't exaggerated in the slightest," says Lee Ti-kai. However, in the face of this rapidly growing cohort, all countries have exhibited chaos. Some elderly are rejected from the nuclear family or are thought of as an unproductive burden on the national economy. Even more disconcerting is that health care for the elderly can lead not only to family frictions, but can overwhelm national health care systems.

Aging is an unavoidable process for us. How to turn these "problem" persons into resources which can be used in society is a goal toward which all governments are striving.

One concept must first be clarified. The definition of "elderly" at 65 is only an indicator used by sociology. However, biologically and psychologically, "elderly" is still in one's own hands, emphasizes Lee Hong-hsin Lee, director of the Department of Health, Executive Yuan. An active 80-year-old has grabbed 20 or 30 more years of life than the lethargic 60-year-old.

The aging process is different for each person because of differences in each organ. But generally speaking, after entering middle age, a variety of symptoms of aging appear. Fading vision, white hair, and loose teeth are the first steps. After 75, even healthy persons can't avoid rapid aging.

First, loose teeth and receding taste buds cause the appetite to decline. This often leads to poor nutrition. The muscular system declines; coordination and response time are not as they once were. A loss of calcium causes the bones to soften. The joints cannot tolerate long periods of friction.

As far as the internal organs are concerned, the amount of blood and oxygen greatly drop in each organ. The regeneration function weakens. For example, the cleansing function of the liver and digestive function of the stomach both greatly decline. According to statistics, the capacity of the lungs and blood flow through the kidneys is only one-half at 80 years of age of what they were at 30. At most, the lung capacity only has 40% remaining, and the greatest working speed declines to 30%.

"You only have to recall these figures and you can understand why the elderly are often ill," points out Hong-hsin Lee.

The decline of the brain or central nervous system, even to the point of a total loss, is the most frightening of all aging phenomena. Because the central nervous system is responsible for calibrating and controlling the body's functions, if it seriously deteriorates, the elderly could be paralyzed or disabled. Alzheimer's disease or Parkinson's disease, whose causes are unclear, are both connected to the decline of the brain, notes Hong-hsin Lee.

With the impact of aging so broad and deep, you can imagine that treatment of the elderly is thorny. This is why geriatric medicine has currently become its own specialty. Teng Kuang-jei, who specializes in researching nervous disorders of the elderly, points out that diseases of the elderly have several special features: They are mostly chronic and deteriorative (they cannot be completely cured), and many diseases have a "domino" effect.

Add to this that the resistance of the elderly to illness is weak, the rate of complications and infection is very high, and thus the rate at which minor illness leads to death increases.

Chen Chien-jen professor of public health at National Taiwan University Hospital, analyzes the problem from the ten leading causes of death. In 1952, a variety of epidemic diseases were the leading killers in the Taiwan area. Today, diseases like cancer, heart disease, diabetes, chronic liver disease, and high blood pressure increase with the extension of average life expectancy.

"Besides cancer, once these chronic diseases occur, the rate of complete cure is extremely small. While not immediately fatal, repeated outbreaks will limit the elderly in eating, working, and physical activity, seriously affecting their quality of life," points out Li Ti-kai.

Being hit by several illnesses at once is another feature. Teng Kuang-jei offers a startling statistic: Of elderly patients seen at the psychiatric clinic of Veterans General Hospital, 37.4% have had more than three diseases. When you add it all up, on the average each person over sixty-five years old has 4.7 major or minor illnesses.

Even worse, many illnesses have "chainlink" relations. High blood pressure, for example, can increase the burden on the heart, even leading to heart attacks or myocardiac infarction.

In a body hit by several illnesses, it's hard to tell what's cause and what's effect. This naturally complicates the key first step--diagnosis. Other problems also make diagnosis of the elderly a major headache for modern medicine.

First, there are no special standards for diseases of the elderly. Doctors are forced to use the general standards for adults; it is hard to avoid deviations. Further, every disease has its specific "classic symptoms"; for example, everyone knows appendicitis is accompanied by intense pain in the mid section. But the elderly can show "non-classic" symptoms. A doctor without experience may not be able to guess the location of the illness. Teng Kuang-jei recalls that one elderly patient complained that her midsection was "stuffy." After an x-ray was taken, they were startled to discover the appendix had already burst, becoming peritonitis.

Hong Kuang-jei indicates that because diagnosis is difficult, many families waste a lot of time and money running from doctor to doctor, clinic to clinic. By the time they discover the actual cause of the illness, their chance for treatment is gone, or their money spent. He stresses cultivating specialists in geriatric medicine, and hopes the concept of geriatric medicine can be spread to every person involved in health care.

Correct diagnosis is only the first step. The second step--treatment--is similarly full of traps.

Because most elderly prefer not to "go under the knife," medication rather than surgery is used to treat illness. But in the realm of geriatric medicine, medication is the toughest course.

The elderly are often suffering from three or four illnesses at once, so it is very common for a person to use six or seven different medications in a day. And some elderly, besides taking the medicine prescribed by their doctor, are in the habit of going themselves to buy medicines at the drug store. The result of all this is that how to avoid medications cancelling each other out or causing reactions is a primary consideration.

One survey shows that the elderly suffer side-effects four times more often than ordinary persons when using medication. "Medications go through no other than the liver, kidneys, lungs, or skin." The organs of the elderly have all declined. The regeneration function is weak. The chances of the medication building up in the body are increased, as are the chances for side-effects.

But the things to look out for in consumption of medicine by the elderly don't stop there. Because the brain cells shrink with age, the weight of the brain decreases. On average, when a person is 70, his brain weight is 5% lower than when they he was 30. The figures are 10% for 80 years old, and 20% for 90. But the body weight doesn't necessarily decrease. If one uses the traditional calculation of dosage based on body weight, overdoses could result.

Also, the adjustment capacity of the elderly is inadequate. For example, high blood pressure can cause a loss of potassium and sodium ions. For young people an imbalance in the ions can be self-adjusted. But for the elderly, even a slight imbalance can show immediate symptoms.

"You only have to add a little salt, then things will be fine," says Teng Kuang-jei casually. But what concerns him is that some doctors who haven't caught on to the idea of geriatric medicine respond, "How can this be an imbalance of ions? I've seen ion levels many times lower than this, and it's never been this problem."

"What's most difficult is that the dosage for the elderly entirely depends on the situation of the individual," says Lee Ti-kai. It's not like dosage for kids, where you can stipulate so much for each age, or adult dosages suitable for most people. "Don't give out medicine that's not necessary, and reduce the dosage of those you do give out. It seems this is a relatively safe method," adds Lee Ti-kai.

"Faced with the elderly, it is necessary to recognize that they are different, and show many different kinds of biological and psychological illnesses. They need family and social support to have active and happy later years," instructs Lee Ti-kai. Only with this kind of psychological preparation can one relatively calmly face the decline of elderly in the family.

One question is often asked: "Ultimately to spend so much money and effort to research how to cure these elderly patients, who are only going to slide gradually down-hill to death, after all what value does this have?"

Nevertheless, "value" changes with time. In primitive tribes, even children often couldn't survive. The elderly not only had to make their own way in the world, they were often forced to end their own lives earlier or even did it voluntarily. But with social progress, people of every status has the right to enjoy these fruits. Teng Kuang-jei says it well: "Think that the elderly have contributed their whole lives to society. And one day you and I will be old. We can only fear that we don't do enough."

[Picture Caption]

Though in old age dusk is already approaching, there is still a long road to travel.

How to maintain activity and health to the very end is a major challenge for modern medicine.

Faced with a bewildering rainbow of medications, how can they be taken with maximum effectiveness?

A young couple with two kids--the model nuclear family. How are the elderly to look after themselves?

Opening one's heart, finding friends outside the home, and staying physically fit--that's the best way to maintain long life.

In the rehabilitation department, most of the people are seniors. The photo shows staff teaching a stroke victim how to cope with a fall.

Maintaining activities as much as possible, and putting off time spent d eteriorating in bed, is the primary responsibility of geriatric medicine.