Transcript
Aging
GracefullyJodi Friedman, MD
Medical Director
Center for Healthy Aging
Northern Dutchess Hospital
April 3, 2019
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This lecture is not
for sissies either.
What is Aging??
The progressive decline and deterioration of functional properties of the body, at multiple levels, that lead to decreased ability to adapt to internal or external stimuli and increased vulnerability to disease and mortality.
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What is Successful Aging?
“A favorable outcome as perceived by the
individual, and his [or her] ability to cope
or adapt to the cumulative changes
associated with the passage of time, while
experiencing a sense of meaning or
purpose in life.”
M. Flood, “Successful Aging: A Concept Analysis,” The Journal of Theory Construction & Testing, 6(2), (2002): 105-108.
Disrupting Age
https://www.aarp.org/disrupt-
aging/stories/ideas/info-2016/what-is-old-
video.html
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Objectives
Describe normal aging and
misconceptions that go with it.
Review the major health domains and
how they impact aging.
Explore things we can do every day to
improve our experience of aging.
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What are we NOT doing?
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Health Domains
Physical
EnvironmentMental
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SUCCESSFUL
AGING
Health Domains:
Physical
Chronic diseases
Approx 80% of older adults have at least one
chronic disease, and 77% have at least two.
Mobility and gait
Cognitive
Sensory
Nutrition
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Aging Quiz-1
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1. The majority (>50%) of older adults will become senile during old age.
2. Declines in all five senses normally occur in old age.
3. Physical strength tends to decline in old age.
4. The vast majority of older adults will at some point end up in a nursing home.
5. Pain is a natural part of the aging process.
1. F
2. T
3. T
4. F
5. F
Normal Aging
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Prevention: Medicare Annual
Wellness Visit
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innovations.ahrq.gov/profiles/physician
practices use software facilitated system
complete medicare annua lwellnessvisit
GanguliI, Souza J, McWilliams JM,
MehrotraA. JAMA. 2017 Jun 6;317(21):2233-
2235
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Medicare started covering preventative services for seniors only since 2011.
In 2014…
Only 7% of older adults receive all recommended preventive services
Only 16% of Medicare recipients had an Annual Wellness Visit
Going to your doctor:
screening Cancer screening:
Mammograms Pap Smears, Prostate exams Colonoscopy
Other: Blood Pressure Osteoporosis –Not just for women! Diabetes Mellitus Depression
Aortic aneurysms: family history, smoking
Vaccines: stay up to date: pneumonia, zoster, tetanus, pertussis
Cognitive Screening
Ageism in Healthcare
1. Potential for over-treatment.
2. Potential for under-treatment.
3. Improper communication during
medical encounters.
4. Patients attributing symptoms to old age.
5. Institutionalized ageism.
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http://www.asaging.org/blog/not-doctors-
only-ageism-healthcare
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https://www.ncoa.org/news/resources-for-
reporters/get-the-facts/healthy-aging-facts/
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Exercise for Prevention:
What does exercise help with?
Insulin sensitivity
Body composition
(muscle vs. fat)
Blood pressure
Cardiovascular
function
Pulmonary function
Lipid profile
Bone mineral density
Muscle strength
Cognitive function
Chronic inflammation
Balance/falls,
Insomnia
Depression
Mobility
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APTA of MA Geriatric Special Interest Group,
2010
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73 YEARS OLD
AGES 79 AND 76
Age 90 and 94
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Harriette Thompson: Finished
the Suja Rock ‘n’Roll Marathon
at age 92.
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Exercise:
Getting Started
Check with your doctor?
Start easy but make it a habit.
Pedometer, park farther away, 1-2
strengthening a day.
Increase by small amounts ever week or
so.
If you are sore, assess the situation.
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Types of Exercise
Poly-pharmacy
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Cognitive
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Reducing Risk of Cognitive
Decline:
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The National Academies, Preventing
Cognitive Decline and Dementia (2017).
Institute of Medicine, Cognitive Aging (2015).
Baumgart, et al., Alzheimer’s & Dementia
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Cognition 2
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N Engl J Med 2016; 374:523-532February 11,
2016DOI: 10.1056/NEJMoa1504327
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In 2016, NEJM,
looked at
Framingham data
over 3 decades:
Found a decrease in
the incidence of
dementia!!!!!
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Nutrition
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https://www.ncbi.nlm.nih.gov/pubmed/1969
9838
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Nutrition
Micronutrients: older adults often
have deficiencies.
Protein: Increase to prevent
decrease of muscle mass.
More evidence on specific diets for
specific diseases: low carb for
Alzheimer’s disease
Aging Quiz
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http://faculty.webster.edu/woolflm/myth.ht
ml
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1. Most older adults have no desire or capacity for sex.
2. Most older adults have difficulty with adapting to change; they are set in their ways.
3. The majority of adults say they are happy most of the time.
4. The majority of older adults say that they are lonely.
1. F
2. F
3. T
4. F
Psychological Issues
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Ageism
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Changes that
come with aging
are seen as
negative, so we
hide them.
Leads to lack of
treatment,
isolation.
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Emotional Intelligence
Ability of individuals to identify different emotions in themselves and others . Use emotional information to guide thinking and behavior. Adapt and manage emotions to achieve goals.
Studies indicate a that this increases with age.
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Dictionary of Psychology
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Aging and Creativity Book, “The Creative Age” explores how to
awaken your potential in the second half of life.
Betty Friedan, author and feminist, wrote “The Fountain of Age” at age 72 and “Beyond Gender: The New Politics of Work and Family” at age 76.
Nelson Mandela, became president of South Africa at age 75.
PD James, British mystery writer, published her last book at age 91.
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Aging and Creativity:
Inventors
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https://www.nytimes.com/2015/04/18/your-
money/more-older-adults-are-becoming-
inventors.html
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“Older inventors bring valuable skills to their work, many experts say, like worldly wisdom and problem-solving abilities that can give them an advantage over younger inventors.”
Psychology: An Attitude of
Gratitude
Gratitude is an affirmation of
goodness in the world and the
recognition that the sources of
this goodness exists outside of
individuals.
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“
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A 2015 article in Scientific American reported that, out of 24 strengths, including love, hope, kindness, and creativity, the single best predictor of good relationships and emotional well-being was gratitude.
Dr. Huffman, psychiatrist at
Mass General.
Psychology: An Attitude of
Gratitude
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DECREASES
Fat consumption
Stress hormone
(Cortisol)
Blood pressure
INCREASES
Sleep quality for
people with
chronic pain
Sleep quality for
people with
difficulty sleeping
Athletic activity
Let’s Take a Body Scan
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Sleep
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Psychological:
Get Enough Sleep
Sleep changes in older adults
DEEP sleep
in REM sleep
Sleep requirements
Medical problems and Medications
Sleep if you are tired
Use non-pharmacologic methods first
Good sleep hygiene
EnvironmentPOLICY
COMMUNITY
FAMILY AND OTHER
CAREGIVERS
HOME
SELF
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Home Environment:
Aging in Place
Aging in place means being able to live in
the home of your choice for as long as
you are able, while being able to get any
assistance you require as your needs
change.
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https://ageinplace.com
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Home
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Social Support
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The Future….
https://www.youtube.com/watch?v=WTj
CYutcGjw
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Social 2: Advanced Directives
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Community:
Rhinebeck@Home
Serving and Staying In Place (SSIP):
Kingston and 209 have websites, New
Paltz
Exercise classes
Senior Centers
Day programs
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Review: The Top 10
1. Participate in disease prevention.
2. Address problems when they arise.
3. Be your own advocate in your
healthcare.
4. Beware of ageist attitudes.
5. Make gratitude part of your lifestyle.
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Top 10 Continued
6. Plan ahead.
7. Take advantage of community
resources and participate in policymaking.
8. Learn something new.
9. Eat right.
10. EXERCISE!!!!
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Resources https://go4life.nia.nih.gov/
713/ref=sr_1_1?ie=UTF8&qid=1509831626&sr=8-1&keywords=the+creative+age
https://www.ncoa.org/healthy-aging/chronic-disease/better-choices-better-health/
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf
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Resources
https://www.drnorthrup.com/goddesses-
never-age-best-years-ahead/
https://ageinplace.com
https://www.aarp.org/livable-
communities/network-age-friendly-
communities/
https://www.acpdecisions.org/
http://www.compassionandsupport.org/
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