By Roger Wells, PA-C
80% of our outcome in life is from our choices at home, not from a medical provider!
Taking care of your physical health is one of the most important aspects of aging.
The amount of activity is directly related to your 10 year life outcome.
A study of 40 years or older patients:
- 8,000 steps or more per day
- 51% lower risk of death from all cause mortality
- Cancer
- Stroke
- MI
- 12,000 steps
- 65% lest risk
- 51% lower risk of death from all cause mortality
Move it or lose it.
Why do I keep gaining weight?
We lose up to 8% of our muscle mass every 10 years as we age.
- Results in fatigue, weakness, and difficulty moving
- Also increases depression risk and general pain
Muscle is the highest user of calories, and therefore we gradually increase our weight as we eat the same and have a continuous loss of metabolic activity.
- Results in falls, poor balance, walking slowly, loss of general stamina
As muscle strength decreases:
- Trip as much but fall more
- Increase osteoporosis risk
- Increase infection risk due to poor pulmonary function
- Cannot complete ADL’s
- Making a bed
- Taking items up and down steps
Why do I feel depressed and lonely?
We lose hearing, vision, and become more forgetful. We have more trouble with getting around, lose family, friends and have a difficult time maintaining social connections. This results in loneliness, but more important, social isolation!
Loneliness is different than depression.
- Feeling of being alone and separated and lack of social contacts and few people to interact with
This increases risk for heart disease, depression and most important cognitive decline. It becomes very important to make NEW social contacts and increase social activity.
Am I developing Alzheimer’s?
It is NORMAL to develop forgetfulness as we age.
To reduce the risk of developing Alzheimer’s, follow at least four of these healthy lifestyle behaviors:
- 150 minutes per week of moderate to vigorous-intensity physical activity
- Not smoking
- Not drinking heavily
- Follow a high quality, Mediterranean-style diet
- Engage in mentally stimulating activities – reading, writing, playing games
Smart phone apps have NOT been associated with any improvement in cognitive ability. Learning a new skill has been shown to improve mental ability.
Sample activities:
- Learn to play a piano
- Editing photos on a computer
- New job/hobby
GET YOUR HEARING CHECKED. We all lose hearing ability as we age, especially high frequency.
- Increases dementia by up to 11%
- Do not understand conversations
- Miss facts and plans
- Top help this:
- Do not sit in the middle of a room
- Sit in a booth or corner
- Look directly at the speaker
- Decrease background noise
Why can’t I sleep?
We require the same amount of sleep at 60-70 than we did at 25 years old.
Sleep matters; medications, illness, pain, etc. can affect sleep. Not enough sleep increases irritability, makes you more forgetful, increases falls, increases depression feelings, decreases ability to do problem solving and concentrating, worse of all, increases risk of dementia later in life. Napping increases the risk of death in the next five years. Poor sleep was associated with increased risk of insulin resistance, heart disease and obesity.
Improving sleep:
- Don’t nap
- Go to bed the same time every night
- Turn off the screens one-two hours before bed
- Read instead of being entertained
- Shower or hot bath one hour before bed
- Become mild chilled
- Quiet dark room without a TV
- Get up after 30-45 minutes as the cycle every 1-2 hours
- Reduce alcohol
- Don’t exercise 2-4 hours before bed
Hypertension
- 50% of all women have elevated BP
- Highest risk of stroke is hypertension
- Goal BP is 130/80 or less
- Small blood vessels become stiff and more narrowed as they try to prevent rupture
- Small lacunar areas become so narrow they cause small vessel disease
- Eventually cognition declines
- Elevated cholesterol makes this worse in some cases
- Walls of the arteries become irritated
- Increases the narrowing
- Watch for side effects from the medications but keep the blood pressure controlled
- Exercise is the most important preventative tool for all people
- Dilates the blood vessel, increases elasticity, enhances blood vessel growth
Diabetes and Insulin Resistance
- Insulin utilizations decreases as we get old
- The body becomes less responsive to the insulin
- It is linked to lifestyle
- Physical activity
- Muscle mass – uses blood sugar without insulin
- Increased mass = Increase sugar use
- Diet
- Sugar intake goes directly to the liver for storage
- Then to visceral fat around the organs
- Decreased Beta Cell function
- Less primary phase insulin output with food
- Results in post prandial blood sugar elevation\
- Treatment:
- Low glycemic index food choices
- Increased muscle activity
- Reduction in weight to decrease size of the body
- Physical activity
Osteoporosis
- Gradual decrease in bone mass and density
- Worsens with ectomorphic structures
- Bones like a bird
- Mesomorphic
- Increased bone density
- Endomorphic
- Increased fat stores
These contribute to genetic risk, HOWEVER:
- Diet, race, medications, lifestyle make a large difference
- Oral meds vs. mild products make a mild difference
- Calcium from milk is better absorptive by the use of lactose in the small colon
Adequate oral calcium and use of vitamin D
- If needed, adequate vitamin D can be used
- Routine vitamin D use is NOT indicated unless you have a risk for deficiency
- Osteoporosis or Osteopenia
- Family history, loss of height > ½ inch
- Meds: PPI, SSRI, some DM medications, > 10 years post menopause
- Recommend to have bone density 10 years after menopause or if you have a vertebral or long bone fracture
- Men over the age of 70 with high risk for thinking bone
- Prostate cancer treatment with anti-testosterone therapy
- DEXA scan – xray exams are the examination test
Osteoarthritis
- No known specific cause of the reason for joint degeneration
- Metabolic, genetic, chemical, mechanical / pre-disposition
- Exercise has been show to stimulate bone and joint healing
- NARCOTICS do not help chronic pain
- Recommend:
- 150 minutes of moderate exercise per week with strength training at least twice a week – low impact
- Maintain a healthy weight
- PROTECT the joints
- Protective shoe wear
- Good posture
- Healthy diet
Prevention:
Diet
- Eat appropriate fruit and vegetables
- Prevents constipation and improves food absorption
- Low “sugar” diet prevents diabetes, weight gain and decreases some cholesterol levels
- Increase the amount of water in the diet
- Improves dry mouth
- Decreases risk for pneumonia and urinary tract infections
Urinary changes
Bladder becomes less elastic and has to void more often, pelvic floor muscles become weaker and have difficulty holding the urine, prostate enlargement causes a decrease in the bladder outflow size.
Treatment:
- Time urinary evacuation
- Maintain a healthy weight
- Don’t smoke
- Stop and start the urine for 3 seconds, 10 times with each voiding
- Avoid constipation
Visual Changes
- Increased risk for fall due to a decreased acuity
- Increase light
- NO throw rugs
- Regular check ups
- Cataracts
- Protein on the cornea
- Gradually increases
- After removal, no close up acuity
Balance
Ability to maintain balance decreases with age, mobility slows, falls increase.
Causes:
- Decreased sensation in the ear, feet and coordination
- Decreased strength
- Decreased cognitive awareness
Treatment:
- Increase balance and mobility exercise
- Increase strength
- Increase quick and safe activity
Medical Check Ups
Should include:
- Vaccinations
- Shingles
- Tetanus, Pertussis
- Pneumonia
- Flu shot
- RSV, COVID-19
- Annual blood tests
- Glucose
- Kidney
- Liver
- Thyroid
- Other screening exams
- Cholesterol, inflammation, mammograms, prostate
- Monitor chronic conditions
- DM, HTM, Lipids, CAD, PVD, Skin
- Cancer screening
- PSA
- Mammograms (yearly/2 years)
- Colonoscopy or Cologuard
- Cervical Cancer Screening
- Other check ups
- Vision
- Hearing