The CHAMP study into geriatric male health
At 91, Stuart Doyle is chuffed that his body still attracts some positive attention. Eight years ago he agreed to allow his ageing bones and a whole lot more to go under the microscope in one of the world’s largest epidemiological studies of its type – one that focuses on men only and restricted to those aged over 70.
Now nearing completion, it went well beyond common geriatric complaints by delving into the health connections between everything from nutrition, dental issues and sexual health to produce some surprising and groundbreaking results.
The study is the first to identify common multiple risk factors that shorten men’s lives after 70. It highlights that some of the traditional risk factors for mortality in younger men such as high blood pressure, high cholesterol, diabetes and obesity are less important in older men.
Doyle, a former RAAF aircrew and government public relations and protocol officer, who is still enjoying life with his second wife, Joan, says he joined the study out of a sense of duty.
“The experience has been splendid, well worthwhile … especially if it improves the wellbeing of us deserving males,” he says with playful sincerity.
Known as CHAMP (Concord Health and Ageing in Men Project) it has involved more than 1700 men in a designated local government area in and around Concord, 15 kilometres west of Sydney.
Sydney University academic Professor Robert Cumming, who specialises in public health and epidemiology, designed the project in the hope of dragging men’s twilight health out of the shadows.
“Epidemiological studies of ageing have tended to focus on women, a phenomenon recognised by sociologists as the feminisation of ageing,” his introductory paper states.
Women’s health generally gets greater attention based on National Health and Medical Research Council figures that for the past decade show a sizeable gap between research linked specifically with males and females. In 2014 – the most recent figures – research tagged “women’s health” received nearly $96 million compared with nearly $18.5 million for projects linked with male health.
Cumming also felt that the four- to five-year shorter life expectancy for men suggested more detailed study of the health of older men was essential.
One of his collaborators and a specialist geriatrician Dr Louise Waite believes the study produced gold in terms of a better understanding of male life span, particularly in identifying risk factors for death in this age group.
As people age, the risk factors for death change and the study found some risk factors are actually the opposite of what is seen in younger people.
“In older men, being overweight is not bad in terms of mortality, and neither is having high cholesterol,” says Waite. “We think that these risk factors matter in midlife but not in older age groups.
“In our group, men who were thinner, still smoking and had previous cancer or heart disease were at greater risk of dying.
“However, it wasn’t only illnesses that predicted death … Men who had trouble doing normal daily activities like shopping and dressing or getting out of a chair were also more likely to die.”
The study found the more of these risk factors the men had, the greater their risk of dying.
“In older men we need to expand our thinking beyond just looking at illnesses that predict death and consider other factors such as daily functions that we have shown are a mortality risk,” says Waite.
The study also looks at the effects of age-related declines in reproductive hormones.
“By just focusing on men we were able to look at testosterone and other reproductive hormones and their impact on a number of health issues,” says Cumming.
“We measured serum [blood] testosterone and found that those who had high levels did not have improved sex lives, bone density or brain function.
“We divided the subjects into groups of high and low levels of testosterone and found the only difference was that the subjects with the higher levels were a little stronger.
“Our results suggest men who buy testosterone supplements are wasting their money but we can only speak with any certainty for men over 70.”
The study, which has been reduced to about 750 because of death and withdrawals, is expected to finish within a year or two and has now reached its fourth two-yearly review, now looking at dental issues.
According to Cumming, some of the significant findings so far include:
Most men in their 70s did not have any of the health problems that are the markers of being elderly. Among those aged 70 to 79, 3 per cent had dementia, 3 per cent needed help to walk across a small room, 6 per cent were incontinent once a day or more, and 6 per cent had had two or more falls in the past year. These conditions only became common among those aged 85 years and older.
Seventy-one per cent of men completed the reproductive health questionnaire, which showed 44 per cent of men had ejaculated at least once in the previous month; 19 per cent had done so at least four times.
High serum testosterone levels were not associated with better health-related quality of life, better cognitive function, lower risk of fractures or lower risk of becoming impotent.
Compared with men born in Australia, men born in Italy (20 per cent of the CHAMP men) were at lower risk of dying during the study period, despite being more likely to smoke and be overweight.
Men who swam regularly were at lower risk of falls than non-swimmers.
Despite not being recommended for this age group by any reputable medical organisation, 38 per cent of men aged 80 years and over had had a blood test (prostate-specific antigen) in the previous two years to screen for prostate cancer.
Cumming says that while the study has at times been a strategic challenge of information gathering, the results so far have exceeded expectations.
“If somebody had told me at the start it would still be going eight years later,” he says, “I would have been very happy, but it’s now getting close to the target of 10 years.
“It has helped us to identify what makes some men age successfully and to live healthier, longer lives.
“Once we fully understand what those factors are we can really start to put strategies in place for the wider population.”
This article was first published in the print edition of The Saturday Paper on Mar 19, 2016 as "Seventy up". Subscribe here.