the jewels in the crown. the diamond queen lucien freud portrait
TRANSCRIPT
The Jewels in the Crown Jewels of Healthy Aging
• Gold of exercise • Pearls of Diet
• Diamonds: The sparkle of social interaction and community involvement in healthy aging .
• The jewel in the crown. Prevention of disability and dementia what we can do to prepare and keep
ourselves healthy as we age
Queen Elizabeth (II)
Oldest reigning British Oldest reigning British and Canadian Monarch and Canadian Monarch Lives in Palaces with Lives in Palaces with lots of servants lots of servants One of her houses One of her houses burned down burned down Three of her four Three of her four children divorcedchildren divorcedBut we like her new But we like her new grand daughter in lawgrand daughter in lawStill working aged 86Still working aged 86
IDT 8
Queen Elizabeth• Long lasting Long lasting
Marriage (celebrated Marriage (celebrated her diamond her diamond wedding in 2007) wedding in 2007)
• Keeps Breakfast Keeps Breakfast cereal in Tupperware cereal in Tupperware boxesboxes
• Simple diet, likes fishSimple diet, likes fish• Occasional glass of Occasional glass of
wine wine • Life long non SmokerLife long non Smoker
IDT 9
Population Aging
• Canada• population over 80
increased by 41% in the years 1991-2001
• Expected to have increased by another 41% by 2011
• 1.3 million Canadians
• Population Pyramid
IDT 12
Baby Boomers
More educatedMore money Greater ExpectationsGreater Life expectancy One still does not have
a job
IDT 13
Barriers to Healthy aging
Modifiable risk Factors • Unhealthy Diet• Physical Inactivity• Tobacco Use
• Raised blood pressure• Raised Blood glucose• Abnormal lipids • Over weight /obesity• Heart disease• Pulmonary disease
Intermediate Risk factors
Sarcopenia (Age related loss of Muscle Mass)
Google Images :Reebok's Guide to Fitness Dana Farber Web Site Survivor's Guide to Fitness DVD
Lean Body mass less than 2 standard deviations From sex specific mean
For young healthy person Importance of Vitamin D in muscle function
IDT May 20101604/18/23
Impact of Frailty• Most adults die from heart disease, cancer
or dementia but for the oldest old the factor which limits their ability to live independently till death is muscle strength. Lambert:: Science 1997
IDT May 20101704/18/23
Frailty
• Non specific state of increasing risk reflecting multi system physiological change
• Strongly age related
• Not necessarily overtly disease related
• Rockwood 2007
• Genes
• Environment • Lifestyle Morley 2006
IDT May 20101804/18/23
Age related physiological deterioration
ExerciseNutrition
Social activityMental activity Presence of disease
Frailty
Functional declineDisability Hospitalization Institutionalization
IDT May 2010
Stressful event
1904/18/23
Impact of Frailty
Most adults die from heart disease, cancer or dementia but for the oldest old the factor which limits their ability to live independently till death is muscle strength. Lambert:: Science 1997
IDT 20
Successful AgingSuccessful Aging
High Level functionHigh Level functionPhysical ActivityPhysical ActivityLife satisfactionLife satisfactionActive engagement Active engagement Independent functionIndependent functionPositive adaptationPositive adaptation(Freedom from Chronic diseases) (?)(Freedom from Chronic diseases) (?)
IDT 21
Successful agingGeneticsGeneticsDietDietFreedom from Freedom from
diseases in childhood diseases in childhood and adult hoodand adult hood
EducationEducationExerciseExerciseAbility to handle stressAbility to handle stressSupport systems Support systems Environment Environment
IDT 22
Studies of Healthy Aging
Predictors of Stabilitymoderate/strenuous
exercise ( no difference in walkers and joggers)
Good exercise patterns life long
Strengthening exercises
IDT 24
Benefits of Exercise Moderate Intensity Exercise
beneficial WALKING- Few complications associated
with exercise safest, cheapest and overall most effective
- Does not need to be prolonged.
Often most effective with associated social interaction
Good to have a friend to walk with you
IDT 25
Type of exercise
• Even standing rather than sitting is exercise• Walking is good safe exercise Strengthening
exercises , repetitions, walking up stairs • Best to start in program with expert
supervision if you have not done it before• Standing up from a chair and sitting down
several times a day
Exercise
• Start Slowly • If it causes no symptoms it is doing no harm • Be cautious in warm weather
A word of warning
• Dont exercise in the heat
• Drink Extra water in the heat
• Don”t stand in the rain for three hours with nothing to drink
DietDiet“ “ She drinks her claret strengthened (I would have said spoiled) with malt whisky “ WE She drinks her claret strengthened (I would have said spoiled) with malt whisky “ WE
GladstoneGladstone Moderate quantities
of red wineModerate amount of
food Dental CareMediterranean Diet
Fish Omega 3 fatty acids and Olive oil
IDT 33
Diet
• Prevention of obesity • Keeping to the recommended salt intake • Mediterranean diet > Fish low saturated fats
and lots of vegetables and fruit• Adequate Calcium• Vitamin D for muscle strength (you can get it
in fish oil ,milk and out in the sunshine
Salt intake
• No Hypertension in societies with low salt intake• Canada has one of the highest salt content in fast
food• Issue for immigrant elders• High content of salt in designer bread and processed
food .• Recommended daily intake 1200mg /day for
persons over 70 ( 1200-2300)
Prescribed Drugs that can adversely affect cognition
Drugs for incontinence
Sleeping Pills Any sedative drug
including Gravol And Many others
IDT 2010 36
Medications
• The more the medications the more likely the adverse reaction
• Ask about side effects• Don’t share medications • Ask your doctor or pharmacist about over the
counter drugs • Don’t look for a pill for every ill • Get them blister packed if you are forgetting to
take them
Copyright ©1997 BMJ Publishing Group Ltd.
Rochon, P. A et al. BMJ 1997;315:1096-1099
Fig 1 Prescribing cascade
3804/18/23
Smart Drugs “Viagra for the Brain ?”
No-otrophicsCoffee Amphetamine like Drugs Donepezil and other
cholinesterase inhibitors No evidence that they
effect dementia incidence
Irene Turpie 201039
Ginkgo Biloba.. $250 million /year spent on Ginkgo in US
Commonly used supplement
No evidence of effectiveness in large randomised controlled trial or 3069 normal community volunteers followed for six years
Given placebo or 120mg twice daily
IDT 2010 40
Depressive SymptomsMacArthur Studies of Successful Ageing
Depression associated with a higher mortality and increased use of medical services
Physical disability a strong predictor of depression
Associated with loneliness
IDT 41
Good support system A good social support
system correlates with successful aging
extended family cohesiveness and frequent contact a feature of centenarians
Social Engagement with other people
Community involvement
IDT 43
Community Involvement
• Seniors largest percapita donor to charity
• 69% of Canadian seniors provide assistance to spouse, children, grandchildren, friends or neighbours
Social Interaction
• 65% of Canadian seniors provide care for other persons
• Seniors are an important source of Volunteer activity
• Frequency of social involvement correlates with self perceived health
• Social involvement more difficult for older people especially if language and mobility a problem
Most people want to live at home
“ “ the environment is what allows us to the environment is what allows us to maintain our state of health . We rely on maintain our state of health . We rely on health care when genetics, and our health care when genetics, and our environment and social policies have environment and social policies have failed us “failed us “
Masotti P 2004 Masotti P 2004 Masotti et al Community Matters in Healthy Aging American Journal of Masotti et al Community Matters in Healthy Aging American Journal of
Public Health 2006Public Health 2006
IDT 47
Importance of Environment NORC Probably more important than
health care Seniors spend more time in their
communities Close to all necessary amenities Close to public transport Adequate Public transport A place to walk to Promotion of places for
socialisation Roads that are safe to cross Services when necessary
IDT 48
Studies of CentenariansStudies of Centenarians
Choose your family or siblings well
Centenarian woman tend to have later menopause
Have children in their 40s
Low incidence cancer in centenarians
Efficient immune responses
Ability to manage stress
IDT 51
Communities that promote independence
IDT May 20105204/18/23
Communities that promote Social Engagementt
Okinawa Island
Highest life expectancy known .. Many centenarians
Regular Exercise Caloric restriction “hari –hachi”
, eat till you are 80% fullModerate alcohol intake Low incidence heart disease
and dementia
Skin aging
AAlways wear a hat lways wear a hat Clear association Clear association
between sun between sun exposure and skin exposure and skin agingaging
Don’t smokeDon’t smoke
IDT 54
Exercise
Weight bearing exercise
Strengthening exercises
Walking even for short periods beneficial in the metabolic syndrome
2.155 kg
Fall PreventionMost seniors fall at least once every year
• Exercise• Balance ( tai chi)• Staywell and other
exercise programs• Watch for dizziness
and check with your doctor.
• Environmental factors
• Revolving doors • Going DOWN stairs• Getting out of chairs
Risk factors for Dementia
Non changeable
• Advanced age Modifiable • hypertension ,
hypercholesterolemia and hypertriglyceridemia
• Atrial fibrillation• Metabolic Syndrome• Head Injury• Cigarette Smoking • Association with less
education • Diabetes
Prescribed Drugs that can affect cognition
Drugs which cause sedation
Benzodiazepines such as lorazepam
Drugs with anticholinergic effects Gravol
Irene Turpie 201058
Walt Disney
The last Jewel Only 30% of variance
in longevity is due to genetics
Exercise diet and life style choices affect aging
Treatment of hypertension reducing the incidence of stroke
Centenarians seem to have learned to manage stress
IDT 60
The Great Star of Africa
Finally Promotion of healthy Promotion of healthy
and successful aging and successful aging depends on more than depends on more than medications and health medications and health carecare
Healthy environment Healthy environment essential essential
Good health behavioursGood health behavioursYou don’t have to be a You don’t have to be a
queen to age wellqueen to age well
IDT 62
Photograph Mark Unsworth Islay Photography