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Healthy Aging
Xaviour Walker MD, MPH, DTMH
Geriatrician, Public Health and Preventive Medicine Physician
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Age
• https://www.youtube.com/watch?v=G43AmXs32Ds
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What is Healthy Aging?
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Charles Eugster – 96 years young!
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Stanislaw Kowalski – 104 at European Masters Athletics Championships
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Shifting the curve to the right
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Burden of Diseases, Injuries, and Risk Factors 1990-2010 (JAMA 2013)
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How would you self-rate your health?
• A - Amazing – I’m a picture of perfect health
• B – Very good – I make a big effort to do what I can, most of the time
• C – OK – I’m doing healthy things when I can
• D – I’m overweight but trying to do a few things
• E – I’m a MI waiting to happen
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I currently…
• A – Exercise >150 min per week moderate intensity, or 75min/week high intensity
• B - Exercise 150 min per week moderate intensity, or 75min/week high intensity
• C - Exercise 150 min per week moderate intensity, or 75min/week high intensity + 2 days strength + 3 days/week balance
• D – I exercise but less.. • E – I don’t exercise
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As a PCP - how successful are you in helping patients make lifestyle changes?
• A – Very successful
• B – Most of the time
• C - Sometimes
• D – Once and a while
• E – I don’t bother, it doesn’t work
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What is your keystone habit
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What is your Kryptonite?
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Insanity is doing the same thing and over and over again and expecting different results.
Albert Einstein
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Environmental factors linked to human behavior and risk factors for CVD
Chow et Int J Epidemiol 2009;38:1580
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NIA Scientific Director
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Compared Characteristics Extended Blue Zone, Restricted Blue Zone, Sardinia
Restricted Blue Zone
Extended Blue Zone
Non Blue Zone Sardinia
Pop. 2001 42,113 432,475 1,199,405 1,631,880
Pop. Density 27.0 33.4 107.7 67.7
Average altitude
588 417 142 280
Centenarians (1880 – 1900)
90 635 497 1132
Extreme Longevity Index
509 264 181 219
Sex ratio Centenarians (1880 – 1900)
0.936 1.346 2.432 1.728
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Why is Sardinia a Blue Zone?
• Genetic pooling
• Sex difference
• Lean, plant based diet, accented with meats
• Pencorino cheese (omega 3)
• Goats milk
• Strong family values
• Role of elders
• Walking – shepherds
• Cannonau wine – high in flavonoids
• Sardonic humor – laughing with friends
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Baltimore Longitudinal Study of Aging
• People who sociable, generous, goal orientated – higher levels of happiness and lower rates of depression
• People involved in hobbies and leisure activities – lower risk for some health problems
• Diet rich in vegetables, fruit, low in saturated fat – decreased CVD and mortality
• Benefits of Exercise
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The North Karelia Project
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The North Karelia Project
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The North Karelia Project
Pekka Puska
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The North Karelia Project
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Making it practical in the clinic
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http://www.ocagingservicescollaborative.org/annual-wellness-visit-toolkit
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Measuring…
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Move..
• Moving naturally
• Morning routine
• Workplace, daily environment
• Balance, Strength, Fitness
• Microhabits
• Being specific, training journals
• Power of consistency
• Using groups
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Robert “Raven” Kraft – 40 years of running 8 miles every day..
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Eat.. • Plant based diet • Removing processed
foods • Drink water. • Recommitment: grocery
list • Clean, uncluttered
kitchen • Healthy precut options in
fridge • Bring own lunch, water • Workplace environment
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Sleep..
• Good sleep hygiene • Same routine • Exercise in morning • No caffeine after 2pm • Last meal 2hours before sleeping • Removing blue light after 6pm • No TV, electronics in bed • Relaxation, bath routine • Bedroom set up • Use of melatonin
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Purpose, People, downshift
• Having a purpose for living
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Purpose, People, downshift
• Having a purpose for living
• Connecting with people – family, friends, others
• Enjoying environment
• Positivity – self, others
• Taking time out
• Mediate, self time
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Doing the doing..
• Micro-habits
• Pre- commitment
• 100% commitment
• Recommitment
• Measure
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Five Ways – Bring Healthy Aging into Clinic
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits . Leverage Community Resources
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits 2. Eat – Whole Foods, Mainly Plants 5. Leverage Community Resources
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits 2. Eat – Whole Foods, Mainly Plants Move - Naturally 5. Leverage Community Resources
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits 2. Eat – Whole Foods, Mainly Plants Move - Naturally Sleep - Hygiene 5. Leverage Community Resources
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits 2. Eat – Whole Foods, Mainly Plants Move - Naturally Sleep - Hygiene 3. Having Purpose and Socializing 5. Leverage Community Resources
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits 2. Eat – Whole Foods, Mainly Plants Move - Naturally Sleep - Hygiene 3. Having Purpose and Socializing 4. Optimize Annual Wellness Visit 5. Leverage Community Resources
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits 2. Eat – Whole Foods, Mainly Plants Move - Naturally Sleep - Hygiene 3. Having Purpose and Socializing 4. Optimize Annual Wellness Visit 5. Leverage Community Resources 5. Leverage Community Resources
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Five Ways – Bring Healthy Aging into Clinic
1. Changing environment + Habits 2. Eat – Whole Foods, Mainly Plants Move - Naturally Sleep - Hygiene 3. Having Purpose and Socializing 4. Optimize Annual Wellness Visit 5. Leverage Community Resources 5. Leverage Community Resources
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Take home points
• Aim to change patients environment and habits vs. behavior and motivation
• Install Keystone habits, remove kryptonite
• Lessons from Blue Zones – Move naturally, Right outlook, eat wisely, Belong
• Plant based diet
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Worlds oldest person: Emma Monoro Born Nov 12, 1899 Age 117
“ Never used drugs, eats three eggs a day, drinks a glass of homemade brandy, and enjoys a chocolate sometimes, but, above all, she thinks positively about the future”.
“Credits her long life to her diet of raw eggs and being single”
Photo from 1930
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Still lives in own home
117th birthday with family
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Useful Book References
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Questions
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Healthy Aging
Xaviour Walker MD, MPH, DTMH
Geriatrician, Public Health and Preventive Medicine Physician