david scrase, md geriatriciandavidscrase.com/david_r._scrase,_m.d./ten_steps_files/ten steps...

David Scrase, MD Geriatrician

Ten Steps to Successful Aging

Topics  for  Today  

•  Ten  steps  to  a  longer,  healthier  life  

•  Ques6ons/Answers  

Ten  Steps  to  Successful  Aging  1.   Exercise  150  minutes  per  week.  2.   Eat  a  healthy  diet.  3.   Watch  your  weight.  4.   Don’t  smoke.  5.   Challenge  your  mind.  6.   Maintain  social  ac6vi6es.  7.   Get  rou6ne  screening  exams.  8.   Get  vaccinated.  9.   Talk  with  your  doctor  about  medica6ons.  10.   Maintain  a  posi6ve  aQtude.  

Quiz  •  Several  years  ago  a  survey  was  taken  of  200  people  who  were  100  years  or  older.  

•  They  were  asked,  “If  you  could  go  back  to  any  age  of  your  life,  what  age  would  you  pick?”  

•  What  do  you  think  was  the  most  common  answer?  

“If  you  could  go  back  to  any  age  of            your  life,  what  age  would  you  pick?”  

A.   21  B.   40  C.   55  D.   70  E.   90    

70!    Why  70?  

     At  age  70,  Benjamin  Franklin  helped  to  draY  the  Declara6on  of  Independence  

Ten  Steps  to  a  Longer  and  Healthier  Life  

•  Staying  healthy  and  staying  independent  are  clearly  connected  

•  Your  ac6ons  have  a  major  impact!  

Ten  Steps  to  Successful  Aging      Step  1  

Exercise 150 minutes per week.

QUIZ:    150  minutes  per  week  of  moderate  exercise  will  reduce  my  risk  of  all  of  the  following  EXCEPT…  •  Stroke  •  High  blood  pressure  •  Coronary  heart  

disease  •  Some  lipid  disorders  •  Adult  onset  diabetes    •  Osteoporosis  •  Depression    

•  Unhealthy  weight  gain    •  Loss  of  muscle  mass,  falls,              and  hip  fracture  over  age  60  •  Colon  cancer  •  Breast  cancer  •  Cogni6ve  impairment                            and    demen6a  

All  of  the  following  improve  with  150  minutes  per  week  of  moderate  exercise:  •  Cardiovascular  system  •  Muscular  system  •  Cholesterol  levels:  higher  HDL  (good  cholesterol)    and  lower  LDL  (bad  cholesterol)  

•  Blood  sugar  level  •  Weight  loss  efforts  •  Sleep  problems  •  Depression  •  Anxiety  disorders    

What  is  MODERATE  exercise?  

•  You  CAN  talk  •  You  CAN’T  sing  •  150  minutes  per  week  =    

– 50  minutes  3  days  per  week  – 38  minutes  4  days  per  week  – 30  minutes  5  days  per  week  – 22  minutes  7  days  per  week  – 10  minutes  15  6mes  per  week  

Be  Physically  Ac6ve  

•  One  study  showed  that  one-­‐half  hour  per  day  of  exercise  in  people  65  and  older  can  extend  your  life  by  3  to  5.7  years,  most  of  that  6me  free  from  disability.  

Source: Living Independently, Harvard Medical School, 2002

Be  Physically  Ac6ve  

Normal Bone Osteoporotic Bone

Exercise  and  Disability  

•  215 disabled patients, average age 75 years in a 6 month exercise program

•  Areas of definite improvement were hip and shoulder abduction, lower extremity strength and tandem gait steps.

•  Net reduction of 15 to 18 percent in physical disability at three and six months, as well as an 18 percent reduction in overall disability at six months

Jette AM, et al. Exercise-it's never too late: the Strong-for-Life program. American Journal of Public Health, January 1999;89:66-72.

What  if  I  Can’t  Exercise?  •  Some  people  have  great  difficulty  exercising  due  to  disability  

•  Strategies:  –  try  very  limited  “exercises”  like  standing,  or  moving  a  wheelchair,  or  liYing  light  objects  

– gradually  increase  dura6on  of  ac6vity  – acetaminophen  prior  to  exercise  – physical  therapy  consulta6on  

Be  Physically  Ac6ve  

Benefit  of  Exercise  

     “If  exercise  could  be  put  in  a  pill  it  would  be  the  number  one  an6-­‐aging  medicine  and  the  number  one  an6-­‐depression  medicine,”  agrees  Dr.  Robert  N.  Butler,  President  of  the  Interna6onal  Longevity  Center,  at  Mount  Sinai  Medical  School  in  New  York  City.    

http://abcnews.go.com/sections/living/DailyNews/ depression_ elderly000921.html

Ellen  DeGeneres  

   “You  have  to  stay  in  shape.  My  grandmother,  she  started  walking  five  miles  a  day  when  she  was  60.  She's  97  today,  and  we  don't  know  where  she  is.”      

Casey  Stengel  

       At  age  71,  began  managing  the                        New  York  Mets.  

Eat a healthy diet.

Ten  Steps  to  Successful  Aging      Step  2  

Eat  a  Healthy  Diet  

Eat  a  Healthy  Diet  

MyPlate.gov  •  Balancing  Calories  

–  Enjoy  your  food,  but  eat  less.  –  Avoid  oversized  por6ons.      

•  Foods  to  Increase    – Make  half  your  plate  fruits  and  vegetables.  – Make  at  least  half  your  grains  whole  grains.  –  Switch  to  fat-­‐free  or  low-­‐fat  (1%)  milk.      

•  Foods  to  Reduce  –  Compare  sodium  in  foods  like  soup,  bread,  and  frozen  meals  and  choose  the  foods  with  lower  numbers.  

–  Drink  water  instead  of  sugary  drinks.      

Take  a  Daily  Mul6vitamin  

JAMA Article Urges All Adults To Take Daily Multivitamin 19 June 2002

by Wyn Snow, Managing Editor Drs. Kathleen M. Fairfield and Robert H. Fletcher, of Harvard Medical School in Boston MA, recommend that all adults take a daily multivitamin. Their two-part report appears in the June 19th issue of the Journal of the American Medical Association.

•  Key  vitamins  for  your  heart  – Folic  acid  =  400  micrograms  (400  mcg)  – B6  =  2  milligrams  (2  mg)  – B12  =  2  micrograms  (2  mcg)  

•  For  your  bones  – Vitamin  D  =  400  interna6onal  units  (400  IU)  – 1,200  milligrams  of  Calcium  per  day  

Take  a  Daily  Mul6vitamin  

•  New  recommenda6ons  – Men  =  maximum  of  two  drinks  per  day  – Women  =  maximum  of  one  drink  per  day  

•  What  is  a  drink?  – 5  oz.  glass  of  wine  – 12  oz.  can  of  beer  – 1.5  oz.  hard  liquor  

• All  of  these  op6ons  =  150  calories  

What  about  alcohol?  

Rita  Rudner          “I  was  a  vegetarian  un6l  I  started  leaning  toward  the  sunlight.”  

Michelangelo  was  71  when  he  painted  the  Sis6ne  Chapel    

Watch your weight.

Ten  Steps  to  Successful  Aging      Step  3  

Watch  Your  Weight  

•  Excess  weight  causes  or  increases  the  risk  of  over  30  illnesses,  including  stroke  and  arthri6s  

•  Two  studies  showed  that  people  who  gained  11-­‐22  pounds  over  several  years  were  three  6mes  more  likely  to  develop  heart  disease,  high  blood  pressure,  diabetes,  and  gallstones  

Watch  Your  Weight  

Orson  Welles    

   “My  doctor  told  me  to  stop  having  in6mate  dinners  for  four.  Unless  there  are  three  other  people  there.”  

Katsusuke  Yanagisawa,    re6red  Japanese  schoolteacher  

     At  age  71,  became  the  oldest  person  to  climb  Mt.  Everest.    

         AYerwards,  he  said,  "No  more  high  mountains."  

Don’t smoke.

Ten  Steps  to  Successful  Aging      Step  4  

Don’t  Smoke  

       Qui>ng  Smoking  Is  S6ll  Beneficial  Among  the  Elderly  by  Ziniah  Beasley,  TSCL  Health  Online  

       Elderly  smokers  who  want  to  quit  can  also  benefit  from  quiQng.  Researcher  David  M.  Burns,  MD,  of  the  School  of  Medicine  at  the  University  of  California,  San  Diego,  states  that  smokers  over  age  60  can  benefit  from  cessa6on  efforts,  and  preven6ve  services  should  not  be  neglected  among  this  popula6on.    

  Source: www.tscl.org/NewContent/100366.asp

Don’t  Smoke  

•  Smoking  is  responsible  for  20%  of  all  deaths  

•  If  you  smoke,  talk  with  your  doctor  about  new  programs  and  medica6ons  that  can  help  you  get  ready  to  quit,  and  then  to  quit  

•  You  begin  to  reap  the  benefits  the  day  you  quit!  

           Adhering  to  the  following  four  healthy  life  styles  had  a  very  strong  impact  on  the  preven6on  of    chronic  diseases:    1.  never  smoking  2.  Exercising  3.5  hours/week  3.  having  a  BMI  of  <  30  and    4.  high  intake  of  fruits,  vegetables,  whole  grain  breads  

and  low  intake  of  red  meat.  

PuQng  the  First  Four  Steps  Together:    A  Recent  Study…  

Source: Ford, et. al., Healthy Living is the Best Revenge. Archives of Internal Medicine 2009;169:1355-1362)

Ford, E. S. et al. Arch Intern Med 2009;169:1355-1362.

Relative chances of having diabetes, heart attack, stroke, and cancer by number of healthy factors

Challenge your mind.

Ten  Steps  to  Successful  Aging      Step  5  

Challenge  Your  Mind  

       “It’s  just  like  any  other  muscle.”  

Source: Living Independently, Harvard Medical School, 2002

MEDICAL ALERT: We interrupt this presentation to announce that even the Harvard Medical

School can make mistakes. Please ignore the above quote.

       Muscle              Brain  

Challenge  Your  Mind  

•  Use  it  or  lose  it!  •  Some  ideas  from  Presbyterian  Medicare  members:  –  take  classes  –  join  a  book  group  – crossword  and  Sudoku  puzzles  – playing  musical  instrument  – kniQng  and  other  hand  craYs  – square  dancing  

Challenge  Your  Mind  

         "The  study  showed  that  the  Alzheimer's  pa6ents  were  consistently  less  ac6ve  in  younger  life  in  all  of  these  ac6vi6es  (passive,  intellectual,  physical),  except  for  TV."    

 Friedland, R.P., et al. 2001. Patients with Alzheimer's disease have reduced activities in midlife compared

with healthy control-group members. Proceedings of the National Academy of Sciences 98(March 13):3440.

Challenge  Your  Mind  

•  Learn  to  use  the  Internet…  – Communicate  with  your  doctor  – Connect  to  your  grandchildren  – Look  into  your  genealogy  – Take  classes  on  line  

•  How  do  I  get  started?  – Classes  at  senior  centers  – Ask  one  of  your  grandchildren!  

     “Give  a  person  a  fish  and  you  feed              them  for  a  day;  teach  that  person  to  use  

the  Internet  and  they  won't  bother                you  for  weeks.”  

Challenge  Your  Mind  

George  Burns,  Actor  

At  age  80,  he  won  his  first  Oscar.  

Maintain social activities.

Ten  Steps  to  Successful  Aging      Step  6  

Maintain  Social  Ac6vi6es  

•  MacArthur  Founda6on  Study:    – the  strongest  predictor  of  well  being  among  older  adults  are  the  frequency  of  visits  with  friends  and  avendance  at  mee6ngs  of  clubs  and  organiza6ons  

Maintain  Social  Ac6vi6es  

•  Bri6sh  Medical  Journal  study  (1999):  – 2,700  American  men  and  women  over  65  –  those  who  were  least  likely  to  avend  church,  travel,  or  seek  out  other  social  ac6vi6es  suffered  a  20%  higher  mortality  rate  from  all  causes  than  those  who  socialized  the  most.  

Pets  

         What  would  you  do  if  your  primary  healthcare  provider  told  you  that  there  was  an  effec6ve  treatment  for  many  older  adults  that:  

•  reduced stress •  helped them deal with grief and loss •  kept them more active •  made depression less likely •  sometimes helped them live longer •  made them less vulnerable to suicide and •  increased their feelings of personal security?

Pets  Help  Seniors  Stay  Ac6ve  

•  Elderly people who own pets are more active than those who do not

•  Pet ownership has "a statistically significant effect on the physical health of older people”

•  Pet owners were "more physically active than non-pet owners”

•  Pet ownership "buffered" the psychological impact of social isolation

Source: Journal of the American Geriatrics Society 1999;47:323-329.

Maintain  Social  Ac6vi6es  

•  Recommenda6ons:  – Take  ini6a6ve  to  schedule  ac6vi6es  – Make  a  difference  in  someone’s  life!  

•  Volunteer  ac6vi6es:  – Presbyterian  (505-­‐841-­‐1501)  – www.volunteermatch.org  – www.seniorcorps.org  – call  our  local  United  Way  chapter  (505-­‐247-­‐3671)  

Maintain  Social  Ac6vi6es  

•  Recommenda6ons:  – Ask  for  help  with  transporta6on  or  see  about  home  visits  

– See  your  doctor  to  get  treatment  for  condi6ons  that  keep  you  at  home  

•  depression  •  anxiety  •  social  phobias  and  low  self-­‐esteem  

Viktor  Frankl,  Physician  and  Writer  

       His  experiences  at  Auschwitz  led  to  his  wri6ng  of  Man's  Search  for  Meaning;  he  con6nued  to  teach  un6l  he  was  85.  

Get routine screening exams.

Ten  Steps  to  Successful  Aging      Step  7  

The  US  Preven6on  Task  Force  recommends  the  following  screenings  for  those  over  65: •  Blood  pressure  •  Height  and  weight  (obesity  

screening)  •  Fecal  occult  blood  test  and/

or  sigmoid-­‐  or  colonoscopy  (up  to  age  75)  

•  Mammogram  every  two  years  up  to  age  74  (women)  

•  Osteoporosis  screening                (women)  •  Cholesterol  (men  over  35)  •  Aor6c  aneurysm  (men  65-­‐75                who  have  ever  smoked)  

Source: http://hstat.nlm.nih.gov/hq/Hquest/db/ local.gcps.cps/screen/Browse/s/43569/cmd/HF/action/GetText?IHR=TIII4

Coco  Chanel  

     Was  the  head  of  a  fashion  design  firm  at  the  age  of  85.  

Get Vaccinated.

Ten  Steps  to  Successful  Aging      Step  8  

Get  Vaccinated  

Shingles  Vaccine  

•  Varicella  Zoster  vaccine  at  age  50  or  later  – Risk  of  having  shingles  aYer  age  80  may  be  greater  than  50  percent  

– Vaccine  reduces  risk  of  acquiring  shingles  by  61  percent  

– Also  reduces  severity  of  episode  and  risk  of  post-­‐herpe6c  neuralgia  (severe  pain)  

Influenza  Vaccine  

•  Influenza  every  year  aYer  you  turn  65  •  Reduces  your  risk  of  influenza  by  58  percent  

•  Reduces  community  risk  of  influenza  as  well  

Pneumonia  Vaccine  

•  Pneumococcal  (pneumonia)  vaccine  at  least  once  aYer  65  

•  Reduces  your  risk  of  contrac6ng  one  of  29  pneumococcal  strains  by  up  to  70  percent  

•  Ask  your  doctor  about  revaccina6on  for  certain  illnesses  and  if  you  received  the  vaccine  before  age  65  

Tetanus  Vaccine  

•  Tetanus-­‐diptheria-­‐pertussis  (TDAP)  booster  every  10  years  

•  Par6cularly  good  idea  if  you  work  outdoors  

•  No  longer  covered  by  Medicare  aYer  age  65,  but…  

•  PHP  covers  this  vaccine  

Albert  Schweitzer,  Physician  and  Humanitarian  

     Was  s6ll  performing  opera6ons  in  his  African  hospital  at  age  89.  

Talk with your doctor about medications.

Ten  Steps  to  Successful  Aging      Step  9  

Talk  With  Your  Doctor  About  Medica6ons  •  Certain  medica6ons  are  now  recommended  for  a  number  of  condi6ons  because  they  have  been  shown  to  lengthen  life  and  reduce  complica6on  – Conges6ve  Heart  Failure  – Myocardial  Infarc6on  (heart  avack)  – Diabetes  – Osteoporosis  

Too  Many  Medica6ons?  

•  On  the  other  hand,  taking  too  many  medica6ons  can  cause  problems  as  well  

•  It  is  a  good  idea  to  bring  all  of  your  medica6on  bovles  (prescrip6on  and  non-­‐prescrip6on)  to  every  doctor  visit  

Marc  Chagall,  Russian-­‐French  Ar6st  

     At  age  90,  became  the  first  living  ar6st  to  be  exhibited  at  the  Louvre  museum.  

Maintain a positive attitude.

Ten  Steps  to  Successful  Aging      Step  10  

Laugh!  

Source: http://www.umm.edu/news/releases/laughter.html

       LAUGHTER  IS  GOOD  FOR  YOUR  HEART,  ACCORDING  TO  A  NEW  UNIVERSITY  OF  MARYLAND  MEDICAL  CENTER  STUDY.  

– may  help  protect  you  against  a  heart  avack,  –  people  with  heart  disease  were  40  percent  less  likely  to  laugh  in  a  variety  of  situa6ons  compared  to  people  of  the  same  age  without  heart  disease.  

Laugh!  

Source: http://www.dailycelebrations.com/072799.htm

Hearty laughter also exercises the lungs and circulatory system and increases the amount of oxygen in the blood.

Mary Pettibone Poole said, "He who laughs, lasts."

Charles  R.  Swindoll  on  AQtude  

     “The  longer  I  live,  the  more  I  realize  the  impact  of  aQtude  on  life.  AQtude,  to  me,  is  more  important  than  facts.”    

Charles  R.  Swindoll  on  AQtude  

•  It  is  more  important  than  the  past,  than  educa6on,  than  money,  than  circumstances,  than  failure,  than  successes,  than  what  other  people  think  or  say  or  do.  It  is  more  important  than  appearance,  giYedness  or  skill.  It  will  make  or  break  a  company...a  church...        a  home.    

Charles  R.  Swindoll  on  AQtude  

•  The  remarkable  thing  is  we  have  a  choice  everyday  regarding  the  aQtude  we  will  embrace  for  that  day.  We  cannot  change  our  past...  we  cannot  change  the  fact  that  people  will  act  in  a  certain  way.  We  cannot  change  the  inevitable.    

Charles  R.  Swindoll  on  AQtude  

•  The  only  thing  we  can  do  is  play  on  the  one  string  we  have,  and  that  is  our  aQtude.  I  am  convinced  that  life  is  10%  what  happens  to  me  and  90%  of  how  I  react  to  it.  And  so  it  is  with  you...  we  are  in  charge  of  our  AQtudes.”    

Grandma  Moses,  Ar6st  

       Painted  her  first  picture  when  she  was  past  80  years  old.    She  completed  over  1,500  pain6ngs  aYer  that;  25%  of  those  were  produced  when  she  was  past  100!  

Celebra6ng  100  years!  

Ten  Steps  to  Successful  Aging  1.   Exercise  150  minutes  per  week.  2.   Eat  a  healthy  diet.  3.   Watch  your  weight.  4.   Don’t  smoke.  5.   Challenge  your  mind.  6.   Maintain  social  ac6vi6es.  7.   Get  rou6ne  screening  exams.  8.   Get  vaccinated.  9.   Talk  with  your  doctor  about  medica6ons.  10.   Maintain  a  posi6ve  aQtude.  

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