staying healthy now and in retirement

Dr. Karen Breeck MD

Feedback@MDPotentials .CAwww.MDPotentials .CA

Feb 2, 2012

Staying Healthy Now and in Retirement

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Are You Ready to Retire ?

Financial Readiness (money)

Lifestyle Readiness (time)

Both assume your HEALTH !!

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Objectives

As a result of this session, you will :

1. Determine your expected lifespan 2. Learn the secrets behind “living to 100” 3. Find out how to “die healthy” 4. Understand how to “age healthy” 5. Take control of your health care6. Identify your next action steps for

“health now and in retirement”

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How many years are YOU going to live ?

Why is this important? Don’t want to outlive your money

For 1000’s years life expectancy = 25 yrs 1800’s = 37 yrs1900’s = 48 yrs 1950’s = 65 yrs

Exercise

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Our “SMART” Goal

To die at _____ years of age

of ______________

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Predicted Life Expectancy - Birth

Average 80.9 Provincial Range 75.2 - 81.4 (6 years)

Men 78.5 Provincial Range 72.5 – 79.2 (7 years)

Women 83.1 Provincial Range 78.5 – 83.6 (5 years)

Stats Can 2008 data last modified 09/27/2011http://www40.statcan.ca/l01/cst01/health72a-eng.htm

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Predicted Life Expectancy - Birth

Average 80.9 ON 81.3

Men 78.5 ON 79.0

Women 83.1 ON 83.4

Stats Can 2008 data last modified 09/27/2011http://www40.statcan.ca/l01/cst01/health72a-eng.htm

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Predicted Life Expectancy - Age 65

Combined = 85.0 (+ 4.1 years - 80.9 )

Men = 83.3 (+ 4.8 years - 78.5)

Women = 86.5 (+ 3.4 years - 83.1)

3.2 year gap between W > M (- 1.3 years gap)

Stats Can 2008 data last modified 09/27/2011http://www40.statcan.ca/l01/cst01/health72a-eng.htm

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Ray Kruzweil - Futurist

IT doubling every yr in exponential manner

1960s computer = ½ building @ MIT 2010 cell phone = 1,000 x powerful, 1m x cheaper and 1 m x smaller = 1b x improved price/performance

2037 (25 years) = 1 b x more powerful and 100,000 x smaller = size of a blood cell

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Ray Kruzweil - Futurist (2)

2039 (27 years) = reverse engineer brains = A.I.

2045 (33 years) = “Singularity” Technology > Human brains Will need to amplify our brains with technology Will spend majority of life in VR.

2050 (38 years) = extension of life Human aging and illness will be reversed World hunger and poverty will be solved We will “cure” death – “immortality medicine”

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Ray Kruzweil – Futurist (3)

Within the next 20 - 40 yrs (?)

Genetics (biotechnology) reprogramming our biology for disease or death

Nanotechnology keeping us healthy from the inside out

Robotics combined with Artificial Intelligence

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How many years are YOU going to live ?

For 1000’s years life expectancy = 25 yrs 1800’s = 37 yrs 1900’s = 48 yrs 1950’s = 65 yrs 1980’s = 75 yrs 2000’s = 80 yrs 1 in 6 alive today will live to be 100 Born in 2007 = 104 yrs - Lancet Journal and www.hrsdc.gc.ca

What age are YOU going to use for your financial planning ?

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Objectives

As a result of this session, you will :

1. Determine your expected lifespan 2. Learn the secrets behind “living to 100” 3. Find out how to “die healthy” 4. Understand how to “age healthy” 5. Take control of your health care6. Identify your next action steps for

“health now and in retirement”

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Live to 100 = Centurions

In Okinawa, Japan studies show

Low-stress lifestyle A diet that heavy on grains, fish, and vegetables

light on meat, eggs, and dairy. Emphasis on walking and gardening. Older adults not isolated within community,

taken care of and continue to work Spiritual sense of purpose

• Santrock . Physical Development and Biological Aging.

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Live to 100 = Centurions

In Okinawa, Japan studies show Mind:

Low-stress lifestyle Body:

A diet that heavy on grains, fish, and vegetables light on meat, eggs, and dairy.

Emphasis on walking and gardening. Social/Spirit:

Older adults not isolated within community, taken care of and continue to work

Spiritual sense of purpose

• Santrock . Physical Development and Biological Aging.

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New England Centenarian Study

Centenarians handle stress better (resilient).Few are obese. Men especially are lean.Smoking history rare.Most have old 1st degree relative.

Many children of centenarians (age 65 - 82) follow parents’ footsteps - low rates heart disease, diabetes and mortality.

Results all put into “www.livingto100.com”

1 in 3 = no changes in their thinking abilities.

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Predictors for Male Centurions

Are marriedAre not overweightHave low blood pressureStrong grip ( overall strength and fitness)Have high education level Have low blood sugarAvoids heavy drinkingDo not smokeHave a low cholesterol.

– JAMA Nov 2011

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Keys to living real old (100)

Diet: low meat, fish, high vegetablesLifestyle: education, don’t smoke, limit

drinking, thin, active, marriage, don’t be poorStress: low or well managed stress Social: Have lots of close friends, be a believer Purpose: family, community, work, volunteerDon’t get chronic disease (cardiac or cancer) Move to Japan and have really old parentsTake www.liveto100.com and make changes !

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Objectives

As a result of this session, you will :

1. Determine your expected lifespan 2. Learn the secrets behind “living to 100” 3. Find out how to “die healthy” 4. Understand how to “age healthy” 5. Take control of your health care6. Identify your next action steps for

“health now and in retirement”

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1. Cancer 29.6 %2. Heart Disease 21.3 %3. Stroke 5.8 %4. Lung Disease 4.6 % 5. Accidents 4.3 % 6. Diabetes 3.8 % 7. Alzheimer's 2.8 %8. Flu/Pneumonia 2.3 % 9. Kidney Disease 1.6 % 10. Suicide 1.6 %

Sources: Statistics Canada, 2008 data, Last modified: 2011-11-01

Total (all causes of death)

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Total (all causes of death)

ALLMEN WOMEN1. Cancer Cancer Cancer 2. Heart Disease Heart Disease Heart Disease 3. Stroke Accidents Stroke 4. Resp DiseaseResp Disease Resp Disease 5. Accidents Stroke Alzheimer’s6. DiabetesDiabetes Accidents 7. Alzheimers Suicide Diabetes8. Flu/Pneumonia Flu/Pneumonia Flu/Pneumonia 9. Kidney Disease Alzheimer’sKidney Disease10. Suicide Kidney Disease Sepsis

Sources: Statistics Canada (2008 data) Last modified: 2011-11-01

22Total (all causes of death)

CANADA1. Cancer 2. Heart Disease 3. Stroke 4. Lung Disease 5. Accidental 6. Diabetes 7. Alzheimer's 8. Flu/Pneumonia 9. Kidney Disease 10. Suicide

*Accidental – cars, drugs, guns, poison, drowning, falls

UNITED STATES1. Heart and Stroke Disease2. Cancer

3. Accidental *4. Lack of Health Insurance5. Suicide6. Infections (Sepsis)7. Alcohol induced8. Homicide9. HIV10. Hepatitis (liver disease)

Statistics Canada, 2008 data Last modified: 2011-11-01

US data (2010) http://drugwarfacts.org/cms/?q=node/30

Increase Odds of Dying Healthy Source: US data 2000 Wikipedia

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DO NOT: % of deaths1. Smoke 18.12. Have poor diet & be inactive 15.23. Abuse alcohol 3.54. Get infectious diseases 3.15. Expose to Toxicants (Pollution) 2.36. Have traffic accidents 1.87. Have firearms accidents 1.28. Get STDs .89. Abuse drugs .7__

5 1.7 %

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Our “SMART” Goal

To die at _100__ years of age of natural causes or “old age”

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Objectives

As a result of this session, you will :

1. Determine your expected lifespan 2. Learn the secrets behind “living to 100” 3. Find out how to “die healthy” 4. Understand how to “age healthy” 5. Take control of your health care6. Identify your next action steps for

“health now and in retirement”

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What is “Age” ?

Chronological – age based on birthday

Biological – age based on body www.RealAge.com (US)

Personalized Action Plan “Doctor’s Visit Plan”

Yes your age can get “Younger Next Year” (2007 - Crowley and

Lodge MD)

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What is “Health” ?

What does “health” mean to you ? How do you define it ? How do you decide if you have it ?

Or don’t have it? How do you decide if someone else has it ?

“Disease is gender specific, health is not”

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Define “Health” ?

A person’s mind, body and spirit, being free of illness, injury or pain (Wikipedia)

The level of functional or metabolic efficiency of a living being (Wikipedia)

A state of complete physical, mental, and social well being and not merely the absence of disease or infirmity (WHO)

Brain’s perfect adaptation of your body to the world it thinks you live in (YNY)

29“Age Healthy” Pre-Requisites

An individual must be able to identify and to realize aspirations, satisfy needs, and change or cope with their environment. - Peace - Shelter - Education - Food - Stable eco-system - Equity- Social justice - Income - Sustainable resources

• WHO’s “Ottawa Charter for Health Promotion” 1986

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How to Age Healthy

Don’t SmokeExercise

Body Brain

Eat Right Supplements ?

Limit AlcoholSleep MoreTake Smart RisksReduce StressScreen for CancerScreen BP

Screen for Cholesterol Don’t get fat Be Happy Have Fun and Laugh Have Friends Get Regular Checkups

Medical Vaccinations

Dental Have a life plan

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Prevent cancers, BP, heart disease, stroke, lung disease and just about everything else...

Best thing to improve your health... QUIT TODAY

DrivenToQuit.ca contest open until Feb 29, 2012

Second hand smoke effects - other adults, kids, pets

“Smoking is the only form of socially acceptable suicide”http://www.worldlifeexpectancy.com/country-health-profile/canada

Don’t Smoke

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Eat Right

Prevent heart, diabetes, obesity, BP, dementia

Use “Eat Right Ontario” dietician lineHeart and Stroke www.healthcheck.orgAll colours of vegetablesFresh > Steamed > Broiled > Frozen* > Can* No white sugar, flour or rice (go whole grain)Mediterranean diet

Accountability partners

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NPN Supplements (2)

Health Canada: www.hc-sc.gc.ca 8-digit Natural Product Number (NPN) on bottle Natural Health Products Database license if safe, effective and high quality

If not licensed No pre - market evaluation or testing No specific disease prevention or treatment

claim No manufacturing consistency assurance

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Exercise, Exercise, Exercise

Prevents heart, obesity, BP, dementia, falls Improves energy, bones, muscle mass, self-

confidence, increased independence Cardio, flexibility, balance and strengthEven 5 minutes a day is better than zeroCan still catch up if starting “late” in lifeWalking 20-30 min most days will do itFind something you like to do..and do it !

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Limit Alcohol

Average 9.8 Litres per person (Rank 46)

Prevent Disease and Death Liver, pancreas, respiratory, immune > disease in women with > 1 drink/day Cognitive loss, depression, addiction Car accidents, falls, drowning, suicide

1/3 motor vehicle deaths alcohol related Screen for addiction

Men 5 x rate of women

http://www.worldlifeexpectancy.com/country-health-profile/canadawww.tc.gc.ca

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Prevent Infections

Get vaccinations Influenza “flu” (Annually) Tetanus (every 10 years) Herpes Zoster “Shingles” (age 60 ) Pneumococcal “Pneumonia” (> age 65) Tropical Diseases (if traveling)

Yellow Fever Meningococcal Hepatitis A and B Typhoid

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Prevent Dental Decay

Decay is from neglect not age Screen for oral cancer, neurological issues, gum disease,

TMJ, grinding (stress), nutritional deficitsPrevent lung and heart disease, stroke and diabetes.

Floss daily Brush after meals (sweets, before bed)

Power brush or change out soft brush 3 months Use antiseptic mouthwashHave exams every 6-12 months (9 months PSHP)

http://www.cda-adc.ca Canadian Dental Hygienist www.cdha.ca

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Prevent Dementia

1. Brain “work outs”– Stay curious Attend educational classes Learn a new hobby, skills or language Numbers/math games “Sudoku “ Laugh – 9 belly laughs a day Learn / play an instrument

Sense of mastery and control in something2. Stay hydrated (brain > 70% water)

> 50 yrs thirst reflex decreased3. Diet, Exercise, Socialize

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Get Enough Sleep

Sleep is an active state not a passive one Regenerative, releases needed hormones

Goal is 8 hours Go to bed and get up at same time: 7 days a week Between 10 -11 pm and 6-7 am best

Sleep Hygiene No TV in bedroom Keep room very dark Have a “step down” hour before bed time

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Take Smart Risks

Prevent Vehicle Accidents Use seat belts Drive within the speed limit Use bicycle helmets Follow boat safety training

Prevent STDs Use condoms

Prevent accidental weapons discharge Have weapon safety training and use lock up

Prevent accidental overdoses Get rid of old pills Don’t mix pills and alcohol Don’t share/take other people’s pills

www.smartrisk.ca

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Develop Stress Resilience

Stress impacts health > 80% of Dr visits are stress related

No one definition for “stress” Fight/ flight “stress” reaction

Stress resilience is a learned skill set Mind: Positive Attitude, Thought Patterns,

Gratitude Body: Exercise Spirit: Sense of belonging, Meditation, Prayer

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Life Plan (1)

Primary Health Care Provider Family Doctor / Walk in Clinic Nurse Practitioner / Physician Assistant

NaturopathOsteopath ChiropractorPodiatristPsychologistOptometristDentist

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Life Planning (2)

Discuss the hard stuff now with your family

1. Organ Donation BeADonor.ca or Service Ontario

2. Living Will Advancecareplanning.ca

3. Power of Attorney - Personal Care AttorneyGeneral.jus.gov.on.ca curateur.gouv.qc.ca

4. Funeral Plans

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Life Plan (3)

CPR - You know it... But does everyone around you ?

New 2010 guidelines... Call 911 Start chest compressions

2 inches deep beat of “Staying Alive”

$35 kit/video from www.cprAnytime.ca Teach your family, friends, and community 20 minutes

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Life Plan (4)

Insurance Coverage Extended Health Care and Dental (PSHP) Travel Out of Country / Province Disability Critical Illness Long Term Care

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Alternative Medicine Practioners

Unlicensed - No professional body oversight

No standards or code of ethicsNo one to complain to if things go wrongRed Flags :

Say THEY can heal you, vice helping YOU heal you

Fear mongering against Western medicine Not interested to work with your doctor/team You need to go more often, not less to them over

time You feel uncomfortable alone with them

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Check for Age and Sex Specific Cancers

BreastProstateColonCervix

Skin (Melanoma)

Order form in binder or go to www.cancer.ca

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Check Blood Pressure

Prevent “silent killer” Heart disease and stroke.

Get checked at least once a year Know your numbers

If high at first, check at different times of day over at least 3 days

Diet, exercise, stress reduction should be considered prior to medications.

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Check Cholesterol Levels

Prevent heart disease and stroke Impacted by diet, exercise, alcohol

Not everyone needs to check just ... Men > 40 Women > 50 or postmenopausal People with diabetes, BP, obesity or smokers Family hx premature heart disease or stroke

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Check if you are Obese

Negative health impact on about everythingOver ¼ Canadians are obese

2 x higher amount then in 1980

BMI ( > 30 kg/m2 )

Waist Circumference Check Men: 102 cm or 40 inches Women: 88 cm or 35 inches

“To feel fit as a fiddle you must tone down your middle.” ~Author unknown

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Check for Diabetes

Not recommended for routine screening !

Only if high BP or Cholesterol Overweight (BMI > 25) and glucose intolerance

Lifestyle interventions Metformin or acarbose medications

Canadian Diabetes Association Screen at 40 and every 3 years

http://www.canadiantaskforce.ca/recommendations/2005_03_eng.html

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Self-Check for Depression

2 weeks or more: Persistent sad, anxious or empty mood Feelings of hopelessness and pessimism Feelings of guilt, worthlessness or helplessness Loss of interest or pleasure in hobbies and activities

Screening Quiz CMHA.ca

Free Educational Modules on moods/emotions Moodgym.anu.edu.au

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Screen for Suicidal Ideation

3500 Canadians took own lives in 2010 7662 died colon cancer and 5105 of breast cancer Most are men aged 15-64 (4 x more successful then

women) Use of lethal means with less warning signs Many have seen their doctor in month ahead Many overdose on alcohol and prescribed drugs

Know when, where and how to get help dcottawa.on.ca 613-238-3311 (1-866-996-0991

Canadian Family Physician Vol 57 Feb 11 p 148

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Objectives

As a result of this session, you will :

1. Determine your expected lifespan 2. Learn the secrets behind “living to 100” 3. Find out how to “die healthy” 4. Understand how to “age healthy” 5. Take control of your health care6. Identify your next action steps for

“health now and in retirement”

55

Take control of your health care

1. Make a shadow medical file Keep journal of doctors, dates, tests, findings, symptoms

2. Internet Research Find support groups – social and often best info Best medical team and location Critical appraisal skills required

3. Become an “E-Patient” Understand the Canadian health care system Know how to self -navigate and -advocate Demand a patient centric system

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Medical Files – who’s is it ?

Personal Health Information Protection Act (PHIPA)

Doctor OWNS the records (Supreme Court). Must keep for 10 years after last entry (College Regulation) 30 years if occupational health practice related

Doctor or Clinics = HEALTH INFORMATION CUSTODIAN (HIC) Gather, create, holds personal information as part of their job HIC/owner relationship is contractual

Patient has right to ACCESS from owner or custodian. Access must be free, copying rarely is....

Ontario Medical Review Mar 2011

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Internet Research - “Trust No One”

Critical Appraisal Skill Sets What country ? Who is paying for the site ? Author’s Credentials ? Advertisements ? Type ? Selling Products ? Advertisements ? Last time page updated ? HonCode designation ?

Prioritize using: Canadian Government, National Health

Associations, Medical Institutions, Support Groups

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Need a “Seniors’ Health Policy”

Need Public Engagement (2014 PHA) Palliative care Home care City Planning

Recreation for Seniors Transport for Seniors Social support for Seniors

Public health programs for Seniors Long Term Care options and facilities Eldercare options

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CARP (www.CARP.ca)

National, non-partisan, non-profit ‘New Vision of Aging (+45) for Canada’

promoting social change that will bring financial security equitable access to health care and freedom from discrimination

Free newsletters on $, health, lifestyle, advocacy

$15/yr membership open to all Free membership to partner (same address) Over 300,000 members to date Many benefits

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CARP Health Wizard

Canadian Health Care Guide Finding care: health care provider, facility, program Managing your health: decision making, tests,

treatments, caregivers Healthy living: workplace, nutrition, lifestyle, travel

Health and Wellness Age specific screening guides Health conditions Medications (OTC, natural and prescription)

Directories Community, groups, associations, provincial guides

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E-Patients say “Let Patients Help”

TED.com = Epatientdave.com Empowered, Equipped, Engaged, Enabled, Equals, Emancipated and Experts

Epatients.net “Health Care Providers Can’t Do It Alone”

ParticipatoryMedicine.org E-patients and Health Care Providers

together

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Objectives

As a result of this session, you will :

1. Determine your expected lifespan 2. Learn the secrets behind “living to 100” 3. Find out how to “die healthy” 4. Understand how to “age healthy” 5. Take control of your health care6. Identify your next action steps for

“health now and in retirement”

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Retire Right (2009) Dr. Fraunfelder MD

Financial planning is not as important to a fulfilling retirement as many think-the psychological experience is just as crucial.

The happiest retirees shared 8 key traits:1. Plan ahead2. Keep a healthy lifestyle3. Engage in leisure activities4. Lean on their support network5. Maintain a positive attitude (of gratitude)6. Accept change7. Have a sense of purpose8. Enjoy some expression of spirituality

These are all skills. Skills can be strengthened, even learned from scratch.

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I commit to...

1. not living like I will never die2. not dying with my music still in me3. considering more then just finances when

deciding my retirement date4. using 100 for my financial planning life

expectancy5. finding out my chronological life expectancy

www.livingto100.com 6. finding out my present biological age

www.realage.com

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I commit to....

7. buying “Younger Next Year” by Crowley/Lodge

8. never starting to smoke9. not exposing myself to second hand smoke10. cutting back on my smoking11. sign up to driventoquit.ca and Quitting ! 12. annual medical check ups 13. annual dental visits14. doing my age / sex specific medical

screening

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I commit to ....

15. keeping a “healthy” waist circumference16. “working out” my brain daily17. learning a new instrument, skill or

language18. laughing every day19. doing a daily act of random kindness20. developing an attitude of gratitude21. learning CPR with my family and friends22. volunteering in my community23. spending more time nurturing

relationships

1.

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I commit to...

24. becoming an organ donor25. making a living will and POA - Personal

Care26. researching critical illness and LTC

insurance27. defining my own “medical team”28. knowing the signs and symptoms of

strokes29. knowing the signs and symptoms of heart

attack30. knowing the signs and symptoms of

depression31. knowing where to find help for depression

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I commit to...

32. shopping for healthier food33. cooking in a more healthy manner34. eating more at lunch and less at dinner35. having more colours in my meals34. walking for 20-30 min most days35. starting exercise for 5 min a day (if at 0

now)36. checking my stress levels www.cmha.ca

quiz37. finding a new “stress buster” strategy

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I commit to....

38. learning to meditate39. knowing my blood pressure numbers40. limiting my alcohol intake41. screening myself for alcoholism42. always wearing my seat belt 43. joining FSNA for the travel insurance44. joining CARP for the health wizard45. joining FSNA/CARP for the advocacy

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I commit to...

46. making my own medical file/chart47. critically appraising all internet health

research48. learning more about the health care

system49. becoming an e-patient50. becoming engaged in the 2014 health care

accord....

....My life is my health and my health is my life...

I am going to live to 100 and die of natural causes !

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I “SMART” commit to....

1. Today ....

2. This Week ...

3. This month .....

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Feedback

(1) What worked for you(2) What didn’t work for you(3) What would you recommend be done

differently for next lecture ?

Email me: Feedback@MDPotentials.caCourse Critique

Course notes and recommended resourceswww.MDpotentials.ca