Issue
Date: March 18, 2001
Aging
with Attitude
The golden years really can be that way for you and your parents
2nd in a year-long series on family health
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USA
WEEKEND health expert Tedd Mitchell, M.D., is a respected
internist, director of the Wellness Program at the renowned
Cooper Clinic in Dallas and a member of the Texas State
Board on Aging. "Older people," he says, "are national
treasures who deserve our efforts to improve the quality
of their lives." See
Mitchell's earlier advice, on children and safety.
Next in the series: Men's health, in June.
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Several months ago, I went to my 20-year high school reunion.
While it was great to catch up with friends, it was also a
wake-up call! Everywhere I turned, hairlines were receding
and waistlines were expanding. Because I grew up with many
of these friends, I also grew up around their parents. Seeing
one another now was eerily reminiscent of seeing our parents
when we were children. Time marches on.
Americans are aging as a population, with a tidal wave of
baby boomers sailing through their 50s toward their senior
years. The "graying" of America is a simultaneously exciting
and anxiety-provoking phenomenon, the likes of which we've
never seen. The excitement stems from the fact that many seniors
enjoy lifestyles and health that their parents could only
dream of. The anxiety stems from needing to care for an increasingly
large segment of the population that doesn't want to lose
its independence.
In this article, I'll review the phenomenon of aging. I'll
touch on caring for the elderly. And I'll detail seven simple
things we all can do at any age to help ensure that our golden
years don't become olden years.
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Exploring the aging phenom
A
century ago, the average life expectancy for an American was
less than 60 years. Leading causes of death were pneumonia/influenza,
tuberculosis and infectious diarrhea. "Preventive" medicine
basically meant quarantine: Because we had no antibiotics
to treat infections, if people became ill they were removed
to a "sick room." Those of us under age 50 don't recall such
epidemics, but our parents may remember people who were sent
to tuberculosis sanatoriums or quarantined for other infectious
diseases. My mother has spoken of a friend who taught school
in Carville, La., in a leper colony. Because there was no
leprosy treatment at the time, and because the disease was
considered horrid, patients at Carville were not even allowed
to get out to vote!
Back in 1928, British bacteriologist Alexander Fleming first
noted the action of a natural substance in killing bacteria.
A decade later, other scientists concentrated this substance,
developing the antibiotic we know as penicillin.
This revolutionized medicine. For the first time, an effective
tool was available to destroy the bacteria responsible for
so many deaths. Penicillin derivatives and other antibiotics
were developed in the 1940s and '50s. Even today, scientists
constantly work to develop new means of destroying microbiological
marauders.
With the advent of the antibiotic era, we saw two things occur.
First, deaths from infections dropped dramatically and lifespans
grew significantly longer. The Census Bureau projects that
an American who is 60 today has 22 years of life ahead!
The second effect of antibiotics was less cheery. We were
living longer but dying from chronic illnesses. Today, the
most common causes of death are heart disease, stroke and
cancer.
Accordingly, preventive medicine has had to change. Fifty
years ago, physicians didn't explain much to a patient, but
simply indicated a therapy. That was OK then. But in 2001,
the more you know about risks for chronic illness, the more
capable you are of making lifestyle changes to improve long-term
health. Our illnesses are related to our habits, so physicians
have become counselors.
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A
7-step action plan for everyone
So, you want to live a long, healthy life? With a little vim
and vinegar in the old machinery? Whether you are 35 and feeling
great or 75 and feeling the weight of the years, here are
some tips to help us enjoy the time we have to the fullest.
Exercise.
It's not just about living longer, but about living better.
I see this all around me in my older patients and friends
who exercised consistently through their lives. They all look
better, have brighter twinkles in their eyes and take on life
with passion. Studies also have shown this phenomenon. A wonderful
study published in 1998 in the New England Journal of Medicine
looked at a group of men and women starting in 1962. At the
time, the group was about age 40. The researchers followed
these people up until the 1990s, when they were in their 70s.
They looked at three lifestyle risks -- physical activity,
obesity and cigarette smoking. The group that had the "low-risk"
lifestyle not only was living longer, but more important,
had what the researchers called "compression of morbidity."
That means they did not develop significant illnesses until
the very end of their lives (in the study, until their final
12 months). The "high-risk" group not only died earlier, but
had increasing health problems over the last several years
of life. More on exercise, pages 10 and 12.
Don't
smoke!
Most people, when they think of cigarette smoking, think only
of lung cancer. But smoking also raises the risk for other
cancers, including mouth, tongue, throat, esophagus, pancreas
and kidney. It substantially increases the risk of heart disease
and stroke. And it is a significant cause of chronic lung
disease (emphysema, chronic bronchitis), an absolutely horrific
illness. Volumes have been written about the detrimental effects
of smoking cigarettes.
Like any habit, it is hard to break. The best thing to do:
Never start. If you are smoking, don't give up hope: The ill
effects on the cardiovascular system seem to be temporary.
Once people have kicked the habit, their risk for heart attack
and stroke drops off dramatically in the next couple of years.
Unfortunately, the cancer risk lingers, and long-term studies
indicate it takes 10 to 15 years before risks get close to
that of the non-smoking population. Occasionally, a patient
will look me in the eye and say, "OK, Tedd, I am 60 and I
smoke. If I stop now, you are telling me that I have to live
until I am 70 or 75 before my risk for cancer even gets close
to that of non-smokers? If that is so, why would I want to
quit?"
"Because,"
I explain, "you are statistically more likely to die from
cardiovascular disease than from cancer, and that risk improves
almost as quickly as you quit smoking!"
I do have the occasional patient who smokes like a chimney
and does not plan to quit. In those cases, I explain that
if they can at least cut back the number of cigarettes, they
will reduce their long-term risks.
Watch
your weight. Imagine somebody who weighed 180 pounds
being asked to carry around a 40-pound backpack constantly.
The effect is immediate and obvious. So is the effect of obesity.
Unfortunately, 1 in 3 American adults is obese and at increased
risk of high blood pressure, high cholesterol and diabetes.
Obesity is associated with increased fatigue, sweating, sleep
disturbance (obstructive sleep apnea) and gastroesophageal
reflux (associated with heartburn). Pain in the hips, knees,
back, ankles and feet are all common in people who are overweight.
Most of the common problems I see in medicine could be helped,
if not eliminated, by maintaining appropriate weight.
What is appropriate? That's a tough one. Unfortunately, many
height/weight charts aren't useful, because they don't consider
body type. Knowing someone's appropriate weight is kind of
like looking at good art: I know it when I see it. For a "guesstimate,"
you can use the body mass index (BMI).
BMI
calculator page
But the best way to determine your appropriate weight is to
have a formal body composition analysis. You could get skin
caliper testing, underwater weighing, or tests using infrared
equipment and electrical impedance. Ask your doctor for a
referral to an exercise physiologist or a reputable health
club. The analysis is important: It corrects unrealistic expectations
and gives you an appropriate goal.
If you consider yourself obese and you can't visit your doctor
to get a body composition analysis, a good starting goal is
to lose 10% of your body weight. For example, if you weigh
250 pounds, start by losing 25 pounds. That is a reasonable
goal for a first step. For some, it may be all the weight
they need to lose. In general, it's best to lose no more than
one or two pounds a week. Faster loss tends to be of water
or lean muscle tissue, which is not desirable.
An ongoing dietary program is absolutely essential for weight
loss: Emphasize a diet high in fruits and vegetables, limit
fatty foods and sweets, don't skip meals, don't eat late at
night, and limit alcohol.
Lower
your cholesterol. Over the past decade or two,
there has been a debate as to whether high cholesterol needs
to be treated in older folks. Well, I come down on the side
of treating it. Not only are newer medications effective,
but they're safe as well. Further, several studies show treating
cholesterol aggressively, especially in people with known
heart disease, improves the long-term outcome.
Not all cholesterol treatment involves drugs. Regular exercise,
a diet low in saturated fats, and an appropriate body weight
all contribute to cholesterol balance. I tell patients that
cholesterol treatment has a parallel pathway, with some things
being done by the physician and other things being done by
the patient. Too often, people begin medication without making
any of the lifestyle changes that can greatly enhance a drug's
effect.
If you have a strong genetic tendency toward high cholesterol,
your liver is genetically predisposed to produce larger amounts
of cholesterol than normal. If you fall into this category,
you may find that your own efforts are not enough. Don't get
discouraged. Keep up the good work, but make sure that you
discuss with your doctor the possibility of medication in
conjunction with your program.
Treat
high blood pressure. This "silent killer" can be
devastating if let alone over years. High blood pressure damages
vessels in the eyes, brain (a cause of stroke), and chest
and abdomen (causing aneurysms). It is associated with hardening
of the arteries (a cause of heart attacks). If the heart pump
works against high pressure, it can eventually fail (the medical
term for this is congestive heart failure). High blood pressure
also is a common cause of kidney disease.
So, what are early symptoms? (This is a trick question.)
Answer: You don't feel anything! That's why it's called the
"silent killer." By the time symptoms appear, the damage is
often irreparable.
Know your numbers. If your blood pressure is consistently
140/
90 or higher, get treated. As a med student, I was taught
that "normal" systolic (top) blood pressure was 100 plus your
age. So, "normal" for a 70-year-old would be 170! We know
better now.
A number of newer, effective blood pressure medicines don't
cause as many side effects as older ones. Follow a routine
of regular aerobic exercise, watch your salt intake and keep
your weight down.
This brings us back to that "parallel pathway" of treatment.
If you have blood pressure problems, buy a home monitor (available
at most drugstores). I like my patients to check their pressure
and write down the numbers so I can better adjust their medications.
With time, you'll know more about your blood pressure readings
than your doctor -- an appropriate goal.
Treat
diabetes. I can't tell you how often patients come
in saying they have been diagnosed with "borderline diabetes."
Listen: The American Diabetes Association recently toughened
its definition of diabetes: It's now more than two fasting
blood sugar results above 125 (normal blood sugar is less
than 120). This represents a dramatic change -- for good reason.
Being diabetic is a bit like being pregnant -- you either
are or you aren't! If you have any history of elevated blood
sugar, take it seriously. Diabetes is associated with eye,
heart, kidney, nerve and vascular disease. Effective drugs
keep the sugar readings treated, and lifestyle changes do
the same. Regular exercise, diets low in saturated fats and
sugars, and appropriate weight all help. (Is a pattern developing
here?) Also, there are wonderful home glucose monitors that
can be bought at the pharmacy. Use them.
Get
regular checkups. You can do many things on your
own to reduce your health risks, but it is important to work
with your doctor to be appropriately screened for illnesses.
As with your car, you have to maintain the machinery with
annual checkups.
There you have it. The good news is, it is never too late
to adopt these guidelines. Go ahead -- start right now. Stand
up, stretch and take a good, deep breath. Great! Finish up
your coffee, put on your sneakers and go for a walk around
the block. You will feel better! Trust me.
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Caring for aging parents
When
I was in high school, my mother's parents moved into the house
next door. The atmosphere at dinner changed, with everyone
slowing down to listen to my grandmother tell of old family
recipes, while my grandfather would, with just a little prodding,
tell stories about his country childhood, the Depression and
World War II. I thought my grandparents moved next door so
we could care for them in their final years. Now,
I realize they gave us far more than we gave them. Such opportunities
should not be wasted by our generation!
In caring for aging relatives, focus on three areas.
Reduce
the risk of disease and disability. Unfortunately,
there's a tendency to assume illness is inevitable after a
certain age. I defy you to tell that to one patient of mine
-- a 70-year-old Senior Olympian cyclist! This man is more
fit than most 30-year-olds, and his complaints need to be
taken as seriously. While none of us can stop the aging process,
we can give Father Time a run for his money. Ongoing care
must include evaluations for cardiovascular and cancer risks.
Have an interactive relationship with a physician.
Develop
fitness and mobility programs.
As we age, we lose muscle mass and aerobic capacity.
Some of the loss is physiologic (we can't help it); a lot
of the changes are adaptive (as we age we do less, which decreases
our capacity). To combat this, get regular physical activity.
Of course, older joints and muscles can't tolerate as much
stress, but appropriate physical activity, done regularly,
definitely adds life to your senior years. An exercise program
should include stretching, aerobics and weight/resistance
training.
Maintain
emotional/mental fitness. Senior citizens want
to care for themselves, so one of their greatest fears is
becoming dependent on those around them. Help people this
age engage in meaningful interactions with others. Unfortunately,
this is the age of Alzheimer's. Some slowing in thinking may
be normal, but it is important to have checkups with a physician
to look for signs of something more than normal aging.
-- Tedd Mitchell
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A vital prescription
Think of exercise as a medicine.
If you underdose, you don't get the full benefits; if you
overdose, there are toxic side effects (exhaustion, injuries).
So, what's enough? The U.S. Surgeon General's Office and the
American College of Sports Medicine recommend "moderate" activity
for at least 30 minutes most days (for my patients, that means
five days a week). That is the dose of "medicine" I prescribe.
Your exercise program should include stretching, aerobics
and weight or resistance training. Lifting weights will increase
your lean body mass. Beginners: Work with a personal trainer
to avoid injuries and maximize results.
Simple weight-training advice:
Do
strength-training exercises two (or better, three) days a
week.
Include eight to 10 exercises involving all large muscle groups
of the upper and lower body.
Lift a comfortable weight, because you should complete 12
to 15 repetitions per set. Try to complete at least one (preferably,
two) sets per exercise session.
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Getting
older? Your doctor should look for this in your regular checkups
LEADING CAUSES OF DEATH:
Heart diseases
Cancer (lung, colorectal, breast, prostate)
Cerebrovascular disease
Chronic obstructive pulmonary disease
Pneumonia and influenza
SCREEN FOR:
Blood pressure
Height and weight
Colon cancer screening
Mammograms and clinical breast exam
Pap test (women)
Prostate exam, PSA (men)
Vision screening
Assess for hearing impairment
Assess for problem drinking
COUNSELING
Substance use. Tobacco cessation. Avoid alcohol/drug
use while driving, swimming, boating, etc.
Diet and exercise. Limit fat and cholesterol; maintain
caloric balance; emphasize grains, fruits, vegetables. Calcium
intake (women). Regular physical activity.
Injury prevention. Lap/shoulder belts. Smoke detector.
Set hot water heater to <120-130¼ F. CPR training for household
members.
Dental health. Regular visits to dental care provider.
Floss, brush with fluoride toothpaste daily.
IMMUNIZATIONS
Pneumococcal vaccine
Influenza
Tetanus-diphtheria (Td) boosters
CHEMOPROPHYLAXIS
Discuss hormone prophylaxis (peri- & postmenopausal women)
Source: The U.S. Preventive Services Task Force
Photo by DARREN CARROLL For USA WEEKEND
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