susan friedman, md, mph krupa shah, md, mph university of ... · 75% consuming 2 or more servings...
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Susan Friedman, MD, MPH Krupa Shah, MD, MPH
University of Rochester Division of Aging 10th Annual Caring For Elders Program
Burgundy Basin Inn April 27, 2016
The aging of America – opportunities and challenges • Demographics; what does “extreme aging” look like?
• Changes in health / chronic disease
• Presence / role of geriatricians
The Blue Zone approach • Principles
• Replication
Behavioral change
Practical ideas to “Blue Zone” your life
Na ta ekatostisis (may you live to be 100). (Greek)
May you live to be 100 years, with one extra year to
repent. (Irish)
May you live to be 120. (Jewish)
May you die in bed at 95, shot by a jealous spouse. (Irish)
May you live to be 100 and may the last voice you hear be
mine. (Frank Sinatra)
Sto lat, sto lat, niech zyje zyje nam (Good luck, good
cheer, may you live a hundred years). (Polish)
6% married
17% live in poverty
Dementia – 37% of those age 90+
Functional status
◦ Over 80% with some activity of daily living impairment
Independence
◦ 15% live alone
◦ 48% live in nursing homes
Centenarians in the US. US Census Bureau, 1999
Kincel B, The Centenarian Population 2007-2011, US Census Bureau, 2014.
Neuroepidemiology. 2007 November; 29(1-2): 125–132
Lived 1875 - 1997
Father lived to almost 100, mother
86, brother 97
Outlived her husband, daughter and
grandson
Met Vincent Van Gogh when she was
13
Saw Eiffel Tower being built
Took up fencing at 85
Lived on her own to 110
Oldest person ever in a movie (114)
Ascribed longevity to olive oil, port
wine and chocolate
Year Life
expectancy
1800 26
1900 47.3 (US)
2013 78.8 (US)
Of all the people who have lived to be 65 or older, half are currently alive.
0
100
200
300
400
500
600
700
2015 2020 2030 2040 2050 2060
Thousands
US Census Bureau, 2014 National Population Projections
NEJM 1980; 303: 130-5.
OR
“The failure of success” - Ernest Gruenberg Milbank Q. 2005 Dec; 83(4): 779–800.
Hippocrates
460 BCE
Never smoker
BMI < 30
Physical activity ≥ 3.5 hours per week
High intake fruits/veg/whole grain, low meat
Ford et al., Arch Intern Med 2009;169(15):1355-62
Arch Intern Med. 2008;168(3):284-290.
Physician’s health study
2,357 men
Ave age 72
5 risk factors:
◦ Smoking ◦ DM ◦ HTN ◦ Obesity ◦ Sedentary lifestyle
Released 2010
2020 Impact Goal
Control risk / promote health
Aim: ◦ ↑ cardiovascular
health by 20%
◦ ↓ CVD and stroke deaths by 20%
“Primordial prevention”
4 health behaviors ◦ Non-smoking
◦ BMI < 25
◦ Physical activity at goal
◦ DASH diet
3 ideal health factors ◦ Total chol < 200
◦ Untreated BP < 120/80
◦ Untreated FPG < 100
Lloyd-Jones et al. Circulation. 2010;121:586-613.
2000
Obesity Trends Among U.S. Adults Behavioral Risk Factor Surveillance System , 1990, 2000, 2010
2010
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
CDC, 2015
0%
10%
20%
30%
40%
50%
60%
Women Men
1988-1994
2009-2010
Ladabaum et al, Am J Med, 2014; 127(8):717-727.
Data from NHANES survey
Healthy people 2010 target
75% consuming ◦ 2 or more servings of fruit
50% consuming ◦ 3 or more servings of
vegetables Vegetables
Fruit
Heart SCORE study
1933 participants
Mean age 59
Community dwelling
Allegheny Cty, PA
66% women
44% African American
1 person had all 7 components
Ave of 2.3
5.3% with 5 or more
Less with ◦ Age
◦ Lower income
◦ African American
Bambs et al. Circulation. 2011; 123(8): 850–857.
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
No chronic disease 4+ chronic diseases
1998
2004
2008
Hung et al. BMC Geriatrics 2011;11:47-58.
0%
20%
40%
60%
80%
HTN Diabetes Cancer COPD Arthritis
1998
2004
2008
Hung et al. BMC Geriatrics 2011;11:47-58.
Changes in mobility disability
0
10
20
30
40
50
60
50-59 60-69 70-79 80+
1998
2006
0
10
20
30
40
50
60
50-59 60-69 70-79 80+
1998
2006
Crimmins et al. J Gerontology Soc Sci 2011; 66B: 75-86.
Women Men
Over age 85
Dependent in activities of daily living
Complex biomedical problems ◦ Multimorbidity
◦ Polypharmacy
Complex psycho-medical situations ◦ Dementia
◦ Depression
Frail
Geriatric syndromes
Warshaw et al. J Am Geriatr Soc 2008;56:1796-1801.
0
1000
2000
3000
4000
5000
6000
7000
8000
2004 2014
Certificates
Certificates
198 201 201 204 200 186
175 178
162 154 135
0
50
100
150
200
20042005200620072008200920102011201220132014
Acti
ve C
ert
ific
ate
s (per
1
million b
enefi
cia
ries)
Year
* Aged 65 and over
Rapidly increasing older adult population
Increasing prevalence of chronic disease
Evidence of increases in disability
Limited number of geriatricians and PCPs
How do we address this?
Interest in health and physical fitness
Active in their own medical care
Information age
Pro-active
Self-motivated
Areas of highest longevity
Live “better” as well as longer
Named for demographers’ maps
Personal interviews
Looked for commonalities
Icaria, Greece • Highest % of 90 year olds on the planet • Almost 1 in 3 reach 90 • 20% less cancer, 50% less heart disease, almost no dementia
Move naturally
Hara hachi bu
Plant slant
Drink alcohol, especially red wine, in moderation
Ikigai or plan de vida - purpose
Reduce stress
Belong to a spiritual community
Keep family first
Surround yourself with people who have similar blue zone
values
The “3-legged stool”
Ikaria Rochester
Albert Lea, MN
• Town of 18,500
• 7 lakes
• History as meatpacking town
• 60-65% overweight or obese
• AARP / United Health Foundation
Town meetings
Personal pledge
Community gardens
Walking and bike paths
Changes in ◦ Restaurants
◦ Schools
◦ Grocery stores
◦ Workplace
“Purpose” workshops
Walking moais
Walking school bus
Community participation
◦ 60% of the city’s restaurants
◦ 51% of employers
◦ 100% of its schools
◦ 27% of citizens
◦ 150 “ambassadors”
• Ave life expectancy increased 3.1 years
• Ave wt loss of 2.8 lbs. each
• 21% drop in absenteeism
• 49% decrease in health care costs in city employees
Buettner, The Blue Zones Solution, 2015.
California Beach cities ◦ Manhattan Beach
◦ Hermosa Beach
◦ Redondo Beach
15 cities and towns in Iowa
Naples, FL
Hawaii
Oregon
Texas
Behavior change in older persons present special challenges: ◦ multiple comorbidities
◦ sensory impairments
◦ reduced mobility
◦ psychosocial factors (loneliness, depression, loss of identity)
◦ dependency
Health behaviors influenced by social network ◦ Smoking ◦ Obesity ◦ Happiness
Influence extends to 3 degrees of separation
42
Christakis and Fowler, N Engl J Med 2007;357:370-9. N Engl J Med 2008;358:2249-58.
British Medical Journal 337 (337): a2338
Movement from South Asia to Europe
Complex changes
Primary trends ◦ Increase in energy and fat intake
◦ Reduction in carbohydrates
◦ Switch from whole grains to more refined sources
◦ Decrease in fiber
◦ More meat and dairy
Higher incidence of ◦ DM2
◦ Obesity
◦ CVD Holmboe-Ottesen et al, Food and Nutrition Research 2012, 56:18891.
To get moving in your Blue Zone, try some of these tips.
Inconvenience yourself
Have fun. Keep moving.
Walk
Make a date
Plant a garden
Enroll in a yoga class
Ergonomic work station
Activity ≠ exercise
To follow 80 % rule in your Blue Zone, try the following tips
Serve and store
Make food look bigger
Use small vessels
Make snacking a hassle
Give yourself a daily reminder
Buy smaller packages
To follow 80 % rule in your Blue Zone, try the following tips
Eat more slowly
Focus on food
Have a seat
Eat early
Try these tips to incorporate more plants in your diet Eat four to six vegetable servings daily
Limit intake of meat
Showcase fruits and vegetables
Lead with beans
Eat nuts every day
Stock up
Introduce a glass of wine into a daily routine
Buy a case of high-quality red wine.
Treat yourself to a “Happy Hour”
Take it easy
To realize your purpose, try the following tips
Craft a personal mission statement
Find a partner
Learn something new
Use these tips to find a quiet space to slow down in your Blue Zone
Reduce the noise
Be early
Meditate
Sleep
De-clutter
To strengthen the spiritual dimension of your Blue Zone, try these tactics
Spiritual does not have to mean religious
Be more involved
Explore a new tradition
Just go
These tips can help you create your family’s Blue Zone.
Get closer
Establish routines ◦ Meals
◦ Holidays
Put family first
Try these tips to build up the inner circle of your Blue Zone
Identify your inner circle.
Don’t be a grump!
Create time together
Create a moai
Timing – we are seeing changes in Demographics
Health trends
Healthcare reform
Changes in lifestyle make a big difference!
The Blue Zones focus on Activity
Nutrition
Connectedness
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