Is old age the new middle age?

Every man desires to live long, but no one wants to grow old. — Jonathan Swift, 18th century

In the 18th and 19th centuries, achieving longevity was hard enough. As human lifespan increased in the 20th century, people set their goals higher, trying to delay the onset of disease and old age. But in the 21st century, we want even more health and vigor in our advanced years. And a study published three years ago says that Swift’s goal was more realistic than he could have ever imagined.

The study evaluated nearly all the residents of Cache County, Utah, who were 65 or older on January 1, 1995. All the subjects provided information about their overall health, along with details about specific aspects of healthy aging, including vision, hearing, activities of daily living, absence of physical illness, mental abilities, mood, social supports and interactions, and religious participation and spirituality.

The results were encouraging. Between the ages of 65 and 75, 80 percent to 90 percent of the volunteers were healthy according to each measure. Even among the oldest of the old, the majorities were independent and considered their health to be excellent or good. Vision and hearing suffered in the oldest old, but social supports and mood remained good. Best of all, perhaps 70 percent of the people, aged 85 and older, retained normal cognition.

The researchers didn’t tell us how their subjects got such good results. Since Cache County is a rural area with a largely Mormon population, it’s likely that high levels of physical activity, good health habits, strong social supports, and spirituality may play a role. Other population groups may have to work harder to achieve these goals, but these optimistic findings should motivate us to aim high at every age. And the earlier you start, the more likely you are to be on target.

For instance, addressing a handful of health risks at midlife can profoundly affect your ability to live to a healthy old age. Meanwhile, new concepts and technologies are helping to make people live longer, stronger, and healthier. Below are some steps you can take — and recommend to friends and aging parents.

Safeguarding Your Health

A 20-year US nationwide survey of people ages 45 to 74 identified five health problems that substantially boost the risk of admission to a nursing home: smoking, inactivity, obesity, diabetes, and high blood pressure (Archives of Internal Medicine, May 8, 2006). These problems contribute to many chronic illnesses that can cause disability and death as we age, including heart disease, stroke, osteoporosis, and certain cancers.

Among those aged 45 to 64, diabetes more than doubled the risk of eventually entering a nursing home. Obesity in the 65-to-74 age group increased the risk by 31 percent. For those aged 45 to 64, physical inactivity boosted the risk of entering a nursing home by 40 percent. Smoking increased the likelihood of a nursing home admission by 56 percent in the younger group and by 32 percent in the older group. High blood pressure also increased the risk by 35 percent in the 45-to-64 group and by 29 percent in the older group.

The effect was even greater when risk categories were combined. For example, diabetic smokers in the younger age group were five times more likely to enter a nursing home than people the same age with no risk factors.

WHAT TO DO

Taking steps to address these five factors could reduce not only the risk of a future assisted living but also the chance of a premature death. Fortunately, most are within our control. Here are several things you can do not only to live longer but also to stay healthier as you age. Keep in mind that these changes interact with and reinforce one another; the more you adapt, the greater the potential payoff:

• If you smoke, talk to your doctor about options for quitting. We all know that smoking is bad for health, but here’s a quick reminder of how bad: It’s harmful from before birth to the end of life, raising the risk of cardiovascular disease, cancer, respiratory disease, osteoporosis, macular degeneration, and cataracts.

• Become more active. Just 30 minutes of brisk walking five days per week reduces the risk of heart attack, stroke, and diabetes; lowers blood sugar levels; decreases depression; and helps activate genes that clear fat and sugar from the bloodstream. Upping your physical activity level to 60 to 90 minutes most days of the week can help you lose weight — and keep it off.

• Improve your diet through some simple changes. Add more servings of dark green, red, orange, or yellow vegetables or fruits to your daily intake with a goal of reaching nine servings per day. And switch to healthier fats: Skip trans fats, choose fewer saturated fats, and get more healthy fats (monounsaturated and polyunsaturated oils and omega-3 fatty acids). Plant oils, nuts, and fish are all good sources.

• To get your blood pressure under control, exercise regularly, don’t smoke, and consider adopting the classic Dash eating plan (www.nhlbi.nih.gov/health/public/heart/hbp/dash). Dash is a diet high in fruits, vegetables, and low-fat dairy products, and low in red meats (and other sources of saturated fats), sweets, and sodium (salt). The OmniHeart trial, published in 2005, showed that you can lower blood pressure even more by eating fewer carbohydrates and more healthy fats and protein. If improved diet and increased exercise alone don’t bring your blood pressure under control, prescription anti-hypertensive medications may help, as long as you take them consistently.

• Talk to your physician about bone mineral density (BMD) testing. All women aged 65 and over (and 70 and over for men) should have their BMD tested. If you’re at high risk for osteoporosis, your doctor may recommend screening at an earlier age. Be sure to get adequate calcium (1,000 to 1,200 mg per day) and vitamin D (800 to 1,000 IU per day).

• Depression is another risk factor to staying healthy as one ages. A 2007 European study that analyzed information from 11 countries on adults, aged 65 and over, found that the more severely depressed a person was, the more likely he/she would be admitted to a hospital or a nursing home facility. There are several possible explanations. Depression can chip away at immune function, heart health, self-care, and the ability to stay active and connected with others. If you think you might be depressed, seek medical attention early.

Personal Experience

Over the 39 years that I have been in private medical practice, I’ve seen countless patients, aged 55 to 65, grow older before their time. But I’ve also seen as many, aged 75, 85, and up, who were full of life and laughter. What makes the difference among such people? Why do some stay young and vibrant despite their “true” age?

If there are any “secrets” to remaining active, energetic and disease-free, here are what I feel are my personal observations based on many years of experience in treating many of these patients who call themselves “sexy senior citizens.”

• Age is not a number, it’s an attitude. No, this isn’t some feel-good mantra, it’s honest medical advice. So don’t count birthdays — just think young!

• Here’s a simple recipe for longevity: Have someone to love, something to do, something to look forward to.

• An older person with high cardiovascular fitness is healthier than a younger person who is physically inactive. By increasing your fitness level, you can actually roll back your biological clock.

• Keep your senses razor sharp at any age.

• Eating right does more than help you lose extra pounds. It promotes strong bones and muscles, beautiful hair and skin, even a good night’s sleep.

• Trade your remote for a pair of walking shoes and cut your risk for heart attack, diabetes, osteoporosis, high blood pressure, high cholesterol, colon cancer, and more. You do have many options for staying young and healthy. But no matter which ones you choose, one thing is for sure — the sooner you start, the sooner you’ll enjoy health benefits and the better off you’ll be in enjoying a future that will be fulfilling, invigorating, and, above all, healthy. –Tyrone M. Reyes, M.D. (The Philippine Star)