physical dimensions of healthy aging ellen f. binder, md division of geriatrics and nutritional...
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Physical Dimensions of Healthy Aging
Ellen F. Binder, MDDivision of Geriatrics and Nutritional Science
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Disclosures of Interest
Research Support:• National Institute of Mental Health• National Institute on Aging
Consulting• Eli Lilly, USA
I own no stocks or equity in any pharmaceutical company.
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“Yet another national placing for Lavelle Kelly”
Tillamook Headlight Herald April 11, 2006
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What Defines Healthy Aging?
• Absence of major disease
• Absence of disability
Defined as inability or great difficulty with ADLs or mobility
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Significance of the Problem• U.S. population > 65 yrs. expected to grow to 20% by
2030 and continue to increase until 2050.
• 40% of the older adult population has some disability or dependency. Such individuals are at high risk for recurrent hospitalization, injurious falls, NH placement, and death.
• The prevalence of chronic disability is higher in older women than among men.
• Although women have a longer total life expectancy they are likely to spend more years than men in a disabled state, even among those with severe disability.
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Disabled Population & RatesNLTCS 1982-2004
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Risk Factors for Disability in Older Adults
• Lifestyle and health habits
• Physiologic changes associated with aging
• Diseases/Conditions
• Social factors
• Economic factors
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Physiologic Changes Associated with Aging
• Hormonal • Body composition, energy intake,
and lipids• Cardiovascular and pulmonary • Renal (kidney)• Hepatic (liver)• Sensory • Cognitive/Neuro-motor
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Changes in Aerobic Power with AgeWomen vs. Men
From Holloszy & Kohrt in Handbook of Physiology-Aging, 1995
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Diseases/Conditions Associated with Disability in the Elderly
• Vascular disease (heart, brain, arteries)• Arthritis• Lung Disease (Asthma, COPD)• Depression• Dementia• Cancer• Diabetes• Malnutrition / Obesity • Falls• Incontinence• Polypharmacy
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Prevalence of Geriatric Impairments by Age Group from CHS
Chaudhry et al. JAGS 58: 1686-92, 2010
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Risk of Disability Onset over 7 Yrs.
HR for Disability# of Geriatric Impairments (GI) or Chronic Diseases (CD) ADL Mobility
GI CD GI CD
1 2 2 1.5 2
2 4 2.5 2 3
≥3 8 3 4 4
From Chaudhry et al. JAGS 58: 1686-92, 2010
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Predictors of Healthy Aging in CHS
• Absence of Hypertension/Lower BP• Lower Waist Circumference (non-obese)• Higher HDL Cholesterol• Absence of diabetes • Regular exercise, especially higher intensity• Moderate intake of wine• Lower clotting factors• No cigarette smoking• No regular ASA use• Stable financial status
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Predicted Median Life Expectancy by Age and Gait Speed
Studenski, S. et al. JAMA 2011;305:50-58
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Exercise Can Reverse Disability Risk in Older Adults
• Muscle strength and power• Body composition, lipids, weight• Aerobic Power• Gait speed • Balance• Flexibility• Bone Density• Mood and Psychological Well Being• Falls
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Components of “Best Practice” Physical Activity Programs
• Attention to health education & exercise “readiness”
• Accessibility• Tailoring of the exercise program to physical
ability and preferences• Multi-component exercises
flexibility, aerobic, strength training• Multiple sessions per week (≥3)• Ongoing social support • Ongoing feedback
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Components of Success for Community-Based Programs
• Collaboration with community agencies and organizations.
• Use of existing programs and infrastructure.• Promotion as a social program.• Planning for wide variability in functional
ability.• Use of an expert advisory board.
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Successful Community-Based Health Promotion Interventions
in Older Adults
• Multi-component falls prevention• Vitamin D replacement
Potential Areas (not disease-specific): • Medication education and compliance• Nutrition and weight management
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Questions???
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From Fried et al. J Gerontol Med Sci 561:M146-156, 2001