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David Scrase, MD Geriatrician

Ten Steps to Successful Aging

Topics for Today

•  Ten steps to a longer, healthier life

•  Ques6ons/Answers

Ten Steps to Successful Aging 1.  Exercise 150 minutes per week. 2.  Eat a healthy diet. 3.  Watch your weight. 4.  Don’t smoke. 5.  Challenge your mind. 6.  Maintain social ac6vi6es. 7.  Get rou6ne screening exams. 8.  Get vaccinated. 9.  Talk with your doctor about medica6ons. 10.  Maintain a posi6ve aQtude.

Quiz •  Several years ago a survey was taken of 200 people who were 100 years or older.

•  They were asked, “If you could go back to any age of your life, what age would you pick?”

•  What do you think was the most common answer?

“If you could go back to any age of your life, what age would you pick?”

A.  21 B.  40 C.  55 D.  70 E.  90

70! Why 70?

At age 70, Benjamin Franklin helped to draY the Declara6on of Independence

Ten Steps to a Longer and Healthier Life

•  Staying healthy and staying independent are clearly connected

•  Your ac6ons have a major impact!

Ten Steps to Successful Aging Step 1

Exercise 150 minutes per week.

QUIZ: 150 minutes per week of moderate exercise will reduce my risk of all of the following EXCEPT… •  Stroke •  High blood pressure •  Coronary heart

disease •  Some lipid disorders •  Adult onset diabetes •  Osteoporosis •  Depression

•  Unhealthy weight gain •  Loss of muscle mass, falls, and hip fracture over age 60 •  Colon cancer •  Breast cancer •  Cogni6ve impairment and demen6a

All of the following improve with 150 minutes per week of moderate exercise: •  Cardiovascular system •  Muscular system •  Cholesterol levels: higher HDL (good cholesterol) and lower LDL (bad cholesterol)

•  Blood sugar level •  Weight loss efforts •  Sleep problems •  Depression •  Anxiety disorders

What is MODERATE exercise?

•  You CAN talk •  You CAN’T sing •  150 minutes per week =

– 50 minutes 3 days per week – 38 minutes 4 days per week – 30 minutes 5 days per week – 22 minutes 7 days per week – 10 minutes 15 6mes per week

Be Physically Ac6ve

•  One study showed that one-‐half hour per day of exercise in people 65 and older can extend your life by 3 to 5.7 years, most of that 6me free from disability.

Source: Living Independently, Harvard Medical School, 2002

Be Physically Ac6ve

Normal Bone Osteoporotic Bone

Exercise and Disability

•  215 disabled patients, average age 75 years in a 6 month exercise program

•  Areas of definite improvement were hip and shoulder abduction, lower extremity strength and tandem gait steps.

•  Net reduction of 15 to 18 percent in physical disability at three and six months, as well as an 18 percent reduction in overall disability at six months

Jette AM, et al. Exercise-it's never too late: the Strong-for-Life program. American Journal of Public Health, January 1999;89:66-72.

What if I Can’t Exercise? •  Some people have great difficulty exercising due to disability

•  Strategies: –  try very limited “exercises” like standing, or moving a wheelchair, or liYing light objects

– gradually increase dura6on of ac6vity – acetaminophen prior to exercise – physical therapy consulta6on

Be Physically Ac6ve

Benefit of Exercise

“If exercise could be put in a pill it would be the number one an6-‐aging medicine and the number one an6-‐depression medicine,” agrees Dr. Robert N. Butler, President of the Interna6onal Longevity Center, at Mount Sinai Medical School in New York City.

http://abcnews.go.com/sections/living/DailyNews/ depression_ elderly000921.html

Ellen DeGeneres

“You have to stay in shape. My grandmother, she started walking five miles a day when she was 60. She's 97 today, and we don't know where she is.”

Casey Stengel

At age 71, began managing the New York Mets.

Eat a healthy diet.


Eat a Healthy Diet

MyPlate.gov •  Balancing Calories

–  Enjoy your food, but eat less. –  Avoid oversized por6ons.

•  Foods to Increase – Make half your plate fruits and vegetables. – Make at least half your grains whole grains. –  Switch to fat-‐free or low-‐fat (1%) milk.

•  Foods to Reduce –  Compare sodium in foods like soup, bread, and frozen meals and choose the foods with lower numbers.

–  Drink water instead of sugary drinks.

Take a Daily Mul6vitamin

JAMA Article Urges All Adults To Take Daily Multivitamin 19 June 2002

by Wyn Snow, Managing Editor Drs. Kathleen M. Fairfield and Robert H. Fletcher, of Harvard Medical School in Boston MA, recommend that all adults take a daily multivitamin. Their two-part report appears in the June 19th issue of the Journal of the American Medical Association.

•  Key vitamins for your heart – Folic acid = 400 micrograms (400 mcg) – B6 = 2 milligrams (2 mg) – B12 = 2 micrograms (2 mcg)

•  For your bones – Vitamin D = 400 interna6onal units (400 IU) – 1,200 milligrams of Calcium per day

Take a Daily Mul6vitamin

•  New recommenda6ons – Men = maximum of two drinks per day – Women = maximum of one drink per day

•  What is a drink? – 5 oz. glass of wine – 12 oz. can of beer – 1.5 oz. hard liquor

• All of these op6ons = 150 calories

What about alcohol?

Rita Rudner “I was a vegetarian un6l I started leaning toward the sunlight.”

Michelangelo was 71 when he painted the Sis6ne Chapel

Watch your weight.


Watch Your Weight

•  Excess weight causes or increases the risk of over 30 illnesses, including stroke and arthri6s

•  Two studies showed that people who gained 11-‐22 pounds over several years were three 6mes more likely to develop heart disease, high blood pressure, diabetes, and gallstones

Watch Your Weight

Orson Welles

“My doctor told me to stop having in6mate dinners for four. Unless there are three other people there.”

Katsusuke Yanagisawa, re6red Japanese schoolteacher

At age 71, became the oldest person to climb Mt. Everest.

AYerwards, he said, "No more high mountains."

Don’t smoke.


Don’t Smoke

Qui>ng Smoking Is S6ll Beneficial Among the Elderly by Ziniah Beasley, TSCL Health Online

Elderly smokers who want to quit can also benefit from quiQng. Researcher David M. Burns, MD, of the School of Medicine at the University of California, San Diego, states that smokers over age 60 can benefit from cessa6on efforts, and preven6ve services should not be neglected among this popula6on.

Source: www.tscl.org/NewContent/100366.asp

Don’t Smoke

•  Smoking is responsible for 20% of all deaths

•  If you smoke, talk with your doctor about new programs and medica6ons that can help you get ready to quit, and then to quit

•  You begin to reap the benefits the day you quit!

Adhering to the following four healthy life styles had a very strong impact on the preven6on of chronic diseases: 1.  never smoking 2.  Exercising 3.5 hours/week 3.  having a BMI of < 30 and 4.  high intake of fruits, vegetables, whole grain breads

and low intake of red meat.

PuQng the First Four Steps Together: A Recent Study…

Source: Ford, et. al., Healthy Living is the Best Revenge. Archives of Internal Medicine 2009;169:1355-1362)

Ford, E. S. et al. Arch Intern Med 2009;169:1355-1362.

Relative chances of having diabetes, heart attack, stroke, and cancer by number of healthy factors

Challenge your mind.


Challenge Your Mind

“It’s just like any other muscle.”

Source: Living Independently, Harvard Medical School, 2002

MEDICAL ALERT: We interrupt this presentation to announce that even the Harvard Medical

School can make mistakes. Please ignore the above quote.

Muscle Brain

Challenge Your Mind

•  Use it or lose it! •  Some ideas from Presbyterian Medicare members: –  take classes –  join a book group – crossword and Sudoku puzzles – playing musical instrument – kniQng and other hand craYs – square dancing

Challenge Your Mind

"The study showed that the Alzheimer's pa6ents were consistently less ac6ve in younger life in all of these ac6vi6es (passive, intellectual, physical), except for TV."

Friedland, R.P., et al. 2001. Patients with Alzheimer's disease have reduced activities in midlife compared

with healthy control-group members. Proceedings of the National Academy of Sciences 98(March 13):3440.

Challenge Your Mind

•  Learn to use the Internet… – Communicate with your doctor – Connect to your grandchildren – Look into your genealogy – Take classes on line

•  How do I get started? – Classes at senior centers – Ask one of your grandchildren!

“Give a person a fish and you feed them for a day; teach that person to use

the Internet and they won't bother you for weeks.”

Challenge Your Mind

George Burns, Actor

At age 80, he won his first Oscar.

Maintain social activities.


Maintain Social Ac6vi6es

•  MacArthur Founda6on Study: – the strongest predictor of well being among older adults are the frequency of visits with friends and avendance at mee6ngs of clubs and organiza6ons


•  Bri6sh Medical Journal study (1999): – 2,700 American men and women over 65 –  those who were least likely to avend church, travel, or seek out other social ac6vi6es suffered a 20% higher mortality rate from all causes than those who socialized the most.

Pets

What would you do if your primary healthcare provider told you that there was an effec6ve treatment for many older adults that:

•  reduced stress •  helped them deal with grief and loss •  kept them more active •  made depression less likely •  sometimes helped them live longer •  made them less vulnerable to suicide and •  increased their feelings of personal security?

Pets Help Seniors Stay Ac6ve

•  Elderly people who own pets are more active than those who do not

•  Pet ownership has "a statistically significant effect on the physical health of older people”

•  Pet owners were "more physically active than non-pet owners”

•  Pet ownership "buffered" the psychological impact of social isolation

Source: Journal of the American Geriatrics Society 1999;47:323-329.


•  Recommenda6ons: – Take ini6a6ve to schedule ac6vi6es – Make a difference in someone’s life!

•  Volunteer ac6vi6es: – Presbyterian (505-‐841-‐1501) – www.volunteermatch.org – www.seniorcorps.org – call our local United Way chapter (505-‐247-‐3671)


•  Recommenda6ons: – Ask for help with transporta6on or see about home visits

– See your doctor to get treatment for condi6ons that keep you at home

•  depression •  anxiety •  social phobias and low self-‐esteem

Viktor Frankl, Physician and Writer

His experiences at Auschwitz led to his wri6ng of Man's Search for Meaning; he con6nued to teach un6l he was 85.

Get routine screening exams.


The US Preven6on Task Force recommends the following screenings for those over 65: •  Blood pressure •  Height and weight (obesity

screening) •  Fecal occult blood test and/

or sigmoid-‐ or colonoscopy (up to age 75)

•  Mammogram every two years up to age 74 (women)

•  Osteoporosis screening (women) •  Cholesterol (men over 35) •  Aor6c aneurysm (men 65-‐75 who have ever smoked)

Source: http://hstat.nlm.nih.gov/hq/Hquest/db/ local.gcps.cps/screen/Browse/s/43569/cmd/HF/action/GetText?IHR=TIII4

Coco Chanel

Was the head of a fashion design firm at the age of 85.

Get Vaccinated.


Get Vaccinated

Shingles Vaccine

•  Varicella Zoster vaccine at age 50 or later – Risk of having shingles aYer age 80 may be greater than 50 percent

– Vaccine reduces risk of acquiring shingles by 61 percent

– Also reduces severity of episode and risk of post-‐herpe6c neuralgia (severe pain)

Influenza Vaccine

•  Influenza every year aYer you turn 65 •  Reduces your risk of influenza by 58 percent

•  Reduces community risk of influenza as well

Pneumonia Vaccine

•  Pneumococcal (pneumonia) vaccine at least once aYer 65

•  Reduces your risk of contrac6ng one of 29 pneumococcal strains by up to 70 percent

•  Ask your doctor about revaccina6on for certain illnesses and if you received the vaccine before age 65

Tetanus Vaccine

•  Tetanus-‐diptheria-‐pertussis (TDAP) booster every 10 years

•  Par6cularly good idea if you work outdoors

•  No longer covered by Medicare aYer age 65, but…

•  PHP covers this vaccine

Albert Schweitzer, Physician and Humanitarian

Was s6ll performing opera6ons in his African hospital at age 89.

Talk with your doctor about medications.


Talk With Your Doctor About Medica6ons •  Certain medica6ons are now recommended for a number of condi6ons because they have been shown to lengthen life and reduce complica6on – Conges6ve Heart Failure – Myocardial Infarc6on (heart avack) – Diabetes – Osteoporosis

Too Many Medica6ons?

•  On the other hand, taking too many medica6ons can cause problems as well

•  It is a good idea to bring all of your medica6on bovles (prescrip6on and non-‐prescrip6on) to every doctor visit

Marc Chagall, Russian-‐French Ar6st

At age 90, became the first living ar6st to be exhibited at the Louvre museum.

Maintain a positive attitude.


Laugh!

Source: http://www.umm.edu/news/releases/laughter.html

LAUGHTER IS GOOD FOR YOUR HEART, ACCORDING TO A NEW UNIVERSITY OF MARYLAND MEDICAL CENTER STUDY.

– may help protect you against a heart avack, –  people with heart disease were 40 percent less likely to laugh in a variety of situa6ons compared to people of the same age without heart disease.

Laugh!

Source: http://www.dailycelebrations.com/072799.htm

Hearty laughter also exercises the lungs and circulatory system and increases the amount of oxygen in the blood.

Mary Pettibone Poole said, "He who laughs, lasts."

Charles R. Swindoll on AQtude

“The longer I live, the more I realize the impact of aQtude on life. AQtude, to me, is more important than facts.”


•  It is more important than the past, than educa6on, than money, than circumstances, than failure, than successes, than what other people think or say or do. It is more important than appearance, giYedness or skill. It will make or break a company...a church... a home.


•  The remarkable thing is we have a choice everyday regarding the aQtude we will embrace for that day. We cannot change our past... we cannot change the fact that people will act in a certain way. We cannot change the inevitable.


•  The only thing we can do is play on the one string we have, and that is our aQtude. I am convinced that life is 10% what happens to me and 90% of how I react to it. And so it is with you... we are in charge of our AQtudes.”

Grandma Moses, Ar6st

Painted her first picture when she was past 80 years old. She completed over 1,500 pain6ngs aYer that; 25% of those were produced when she was past 100!

Celebra6ng 100 years!

Ten Steps to Successful Aging 1.  Exercise 150 minutes per week. 2.  Eat a healthy diet. 3.  Watch your weight. 4.  Don’t smoke. 5.  Challenge your mind. 6.  Maintain social ac6vi6es. 7.  Get rou6ne screening exams. 8.  Get vaccinated. 9.  Talk with your doctor about medica6ons. 10.  Maintain a posi6ve aQtude.

Questions and Answers

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