Healthy Aging Archives • Marc Spero, MD

Archive For: Healthy Aging

Ageism, the Last Unacceptable Bias

“I’m having a senior moment.

I’m too old to try that.

I look good for my age.

It’s time to put her/him out to pasture.

These are just aches and pains from old age.

Sweetie, you don’t look a day over 29.

Ok boomer.

There will be a tsunami of aging dependents in the coming decade.”

These oft-used phrases may sound inoffensive but they’re actually examples of ageism, perhaps the only stereotype in America yet to be banished, or even fully recognized. Raising awareness of ageist beliefs as inaccurate at best, and physically and psychologically harmful at worst, is the work of a lifetime for a diverse group of medical and scientific advocates. Why is changing the narrative so important?

Research shows that ageism can influence health through three pathways: psychological, behavioral and physiological. Negative age stereotypes can increase biological markers of stress and may predict detrimental brain changes decades later, while also spurring worse health behavior, such as noncompliance with prescribed medications. A national poll on healthy aging showed those who regularly experienced three or more forms of ageism were less likely to rate their mental health as excellent or very good (61% vs. 80%) and more likely to report symptoms of depression (49% vs. 22%) than those who did not. Additionally, ageism can lead to inequities in healthcare, with age-based exclusions common in clinical trials, and older adults more apt to be left out of screenings, investigations and treatment for mental health issues.

Ageism: A Mental and Physical Toll

What may be most important to appreciate is how the internalizing of age stereotypes by older adults themselves can be an important determinant of health and well-being. Experts have found that negative self-perceptions of aging are associated with a higher prevalence for many of the most frequently seen health conditions among Americans, including heart disease, lung disease, diabetes, musculoskeletal disorders, and injuries, and tend to show more shrinkage of hippocampal volume in the brain. They may also show poorer memory performance and start to walk slower, reinforcing the negative loop around their aging process.

The Power of Positive Aging

Flipping the narrative, however, can result in dramatically improved outcomes. As reported in the Gerontologist, those who have more positive age beliefs live on average 7.5 years longer than those who harbor negative age beliefs. As the researchers noted: “If there were a pill that gave people an extra seven years of life in relatively good health, we would encounter very long lines at the pharmacy.”

The reasons for optimism around aging are based on science, not magical thinking. Consider that steep declines in physical and cognitive abilities are not inevitable parts of aging. According to the Administration on Aging, 80% of adults over 65 are not experiencing a physical or cognitive disability such as hearing impairment or memory loss that impacts their function, and 60% report only moderate or small impairments in their mobility. Procedural memory (e.g. how to ride a bike) is maintained in normal aging, and there is evidence suggesting abstract thinking and metacognition improve.

Challenging the Aging Myth

Despite the stereotype of people becoming more curmudgeonly with age, Manfred Diehl, PhD, a lifespan developmental psychologist, reports the opposite: “The conclusion from several meta-analyses is that in the personality area, we see quite a bit of positive development in terms of becoming socially more mature, with improved coping strategies and more regulation of emotions. Conscientiousness tends to increase at least until the mid-60s, possibly early 70s.”

Most remarkably, ongoing research at the Yale School of Public School by epidemiologist Dr. Becca Levy pointed to the conclusion that beliefs about aging rather than aging itself help explain why some older adults thrive while others do not. Her studies found that adults briefly primed with positive statements about aging showed improvements in their memory, gait speed, and balance that were measurable months later, and further generated increasing confidence in their abilities that endured over years. Additional studies suggest that positive beliefs about aging may protect against dementia, even among those with a high-risk gene.

Changing the Conversation Around Aging

How can we help shift the conversation? Start by increasing awareness of the culture of ageism around us and recognize how it can impact health rather than the actual aging process, encourages Levy.

You may also want to explore how to get involved in organizations that focus on bringing generations together, including:

Generations Over Dinner – A free global initiative to create meaningful experiences and conversations by hosting in-person or virtual multi-generational dinner events.

Generations United– A nonprofit network with a comprehensive database of intergenerational programs across the country.

CoGenerate –A nonprofit organization aiming to bridge generational divides and foster intergenerational collaboration.

When to seek help for mental health

Remember: it is not normal for older adults to be unhappy as they age. Seek help for these treatable medical conditions:

Anxiety

Panic disorder: Panic attacks or sudden feelings of terror that strike repeatedly
Obsessive-compulsive disorder: Repetitive, unwanted thoughts or rituals
Post-traumatic stress disorder (PTSD): Nightmares, depression after a traumatic event
Phobias: Extreme fear of something that poses little real danger
Generalized anxiety disorder: Chronic worry about everyday activities

Depression

Feelings of intense sadness that last for weeks or months. Symptoms include:

No pleasure in everyday activities
Poor sleep
Rapid weight gain or loss
Low energy
Unable to focus

While grieving a loss may look similar to depression, there are differences. A mix of good and bad days is common when grieving. With depression, feelings of emptiness are constant and don’t improve over time.

Sources:Aging Research Reviews; Breaking the Age Code; Contemporary Clinical Trials, NCOA, Helpguide.org

A New Look at Moving through Menopause

Defined simply as the final menstrual period, when it is no longer possible for a woman to get pregnant, the current approach to menopause has become increasingly nuanced, recognizing that each individual’s experience varies widely. Many women transition into this stage smoothly with minimal discomfort, but others experience severe vasomotor symptoms such as hot flashes, night sweats, sleep disruption, vaginal dryness, and possibly, “brain fog” and poorer mental health.

The Popularity of Hormone Therapy for Menopause

While hormone therapy (HT) was once routinely prescribed to relieve the symptoms of menopause, this stopped as a result of a large Women’s Health Initiative (WHI) study in 2002 which showed an increased risk of heart attacks, breast cancer, blood clots, and strokes for older postmenopausal females using the estrogen-progestin combination.

However, the pendulum may now be swinging back as subsequent trials that addressed the limitations of the WHI study found hormone therapy – consisting of estrogen for symptom relief and progesterone to protect the uterine lining – may be safer than previously thought. For women under 60 who are less than 10 years out from the start of menopause, an estradiol oral pill or transdermal patch can eliminate symptoms that impact sleep and mood and may decrease the risk for heart disease, diabetes and fractures due to osteoporosis. Progesterone can be taken as a pill, patch or IUD.

Further studies have shown that HT needn’t be routinely discontinued after 10 years for women at low risk for breast cancer and cardiac disease who continue to be challenged by persistent menopause symptoms.

Depression and Menopause

Additionally, new research suggests that despite a long-held association of depression with menopause, women are not universally at risk of depressive symptoms over the transition. For those more vulnerable to depression because of severe sleep disruptions, a long transition through menopause, stressful life events, or a previous history of clinical depression, a combination of psychological interventions and medication is advised. Other studies found estrogen treatment, sometimes with an antidepressant, effective in managing mood-related symptoms.

A Healthy Lifestyle to Mitigate Menopause Symptoms

The renewed acceptance of HT has spurred a reconsideration of our entire approach to menopause with practitioners asking: Can a healthy lifestyle play a key role in mitigating menopause symptoms? Can this passage be navigated successfully with informed, individualized decision-making and social and medical support? In 2024, all signs point to yes.

How Not to Age: A Scientific Approach to Getting Healthier as You Get Older

It’s not yet possible to stop the passage of years, but it might well be within our sights to combat the effects of aging, according to Michael Greger, MD, internationally recognized lifestyle medicine physician, author and nutritionist. Synthesizing years of research on the essential pathways of aging, Dr. Greger believes the process can be slowed down with lifestyle changes, and without pharmaceutical interventions. Below are some of his most interesting findings … please note that we always encourage you to check with your physician for individual guidance before adopting new health recommendations.

Plant-based eating holds one of the most important keys to slowing biological aging, emphasizes Dr. Greger. Borne out in large studies from the National Institutes of Health/AARP and Harvard, replacing just 3% of daily calories from animal protein with plant protein was associated with a 10% decrease in risk of overall mortality. It may also help prevent Alzheimer’s dementia, an incurable disease. “There is a growing consensus that what is good for our hearts is also good for our heads, and high levels of blood cholesterol are recognized to be a major risk factor for Alzheimer’s. Switching to a healthy, whole foods diet lower in animal fats, eggs and dairy can help prevent arteries in the brain from becoming clogged with atherosclerotic plaque, which is thought to play a role in Alzheimer’s,” he explains. “It may even trump genetics, as seen in Nigeria, where the plant-predominant diet may be the reason for very low rates of Alzheimer’s disease among a population with some of the world’s highest rates of the Alzheimer’s gene. Genes may load the gun, but lifestyle pulls the trigger.” In studies of older adults, the benefits of a diet rich in dark green, leafy vegetables continues to emerge, associated with improvements in the brain’s processing speed and working memory, muscle mass and strength, and potentially helping prevent age-related macular degeneration.

Activate autophagy, the body’s cellular recycling system, with regular aerobic exercise of moderate intensity, and daily consumption of spermidine, a compound found in foods including: beans, tempeh (made from fermented soybeans), white button mushrooms, mangoes, edamame, green peas, lentil soup, and in its most concentrated form in wheat germ. Also given the green light by Dr. Greger is coffee, for its abundance of polyphenol chlorogenic acid, an antioxidant thought to have a protective effect that is contained in all types of the beverage (decaffeinated, instant, and especially when brewed with a paper filter).

Avoid French fries and chips, urges Dr. Greger, as the toxin acrylamide formed during the frying process may cause inflammation and inhibit autophagy; air fry potatoes instead. Also, put down the salt shaker and opt for salt-free seasonings or substitutes. “Cutting back on sodium appears to effectively make people more than a decade younger in terms of risk of premature death,” he says.

Minimize fish. Long viewed as a healthy choice, fish have become so contaminated with heavy metals, pesticides and other forever chemicals that despite their omega-3 fatty acids, there’s been a failure to consistently observe its beneficial effects, according to Dr. Greger.

Prevent bone fractures by focusing on strength and balance training. “The majority of age-related risk of bone fractures (85%) is due to falling, not osteoporosis, so addressing muscle loss may be more effective than the current focus on increasing bone mineral density with drugs,” says Dr. Greger. He cites multiple randomized trials showing a combination of resistance exercise to improve lower limb muscle strength and balance training can cut fracture risk nearly in half. And although boosting protein intake has been touted by others, Dr. Greger cautions: “If you put together all the randomized, controlled trials of adding extra protein to the diets of older men and women, you find no evidence that it increases muscle mass or strength, even in those with sarcopenia (excessive age-related muscle loss).”

Finally, he points to the reassuring fact that adopting just a few simple lifestyle behaviors – a diet rich in fruits and vegetables, maintaining a healthy weight, not smoking – adds years of life no matter when you begin. “A Harvard analysis of more than 100,000 men and women followed over decades showed that starting to eat and live more healthfully at age 50 appeared to translate into 12 to 14 years of extra lifespan, at age 60, an extra 8 to 9 years, and even starting at age 80 added more years. We all have the power to turn back the clock, starting right now.”

Eight Lessons from the Blue Zones

Blue Zones are areas across the globe in which populations live longer and better than average, identified by National Geographic fellow Dan Buettner, who explains: “There’s no magic bullet or pill, but rather a cluster of mutually supporting factors common to these centuries-old cultures whose people are making it to ages 90-100 without disease.”

Plant-slant diet, as described elsewhere in this issue. Buettner’s common sense advice: “Sit down with a plant-based cookbook, identify a dozen recipes that you think your family would enjoy and cook them instead of going on a diet or spending money on a program. Also, eliminate soda pop, one of the unhealthiest parts of the American diet.”
Eat until you’re 80% full. “And have your biggest meal first,” advises Buettner, “eat breakfast like a king, lunch like a prince and dinner like a pauper.”
Family-first focus.
Belonging: feeling connected to your community.
Right tribe: surrounded by friends who support healthy behaviors.
Natural movement throughout the day.
Strong sense of purpose.
Ability to de-stress.

The original Blue Zones ranged from Costa Rica to Sardinia. According to new research, these states closer to home are most likely to earn the moniker in the future: California, Minnesota, Utah, North Carolina, Massachusetts, Maryland, Virginia, Connecticut, Rhode Island, Colorado.

How Not to Age: A Scientific Approach to Getting Healthier as You Get Older

Eight Lessons from the Blue Zones

Plant-slant diet, as described elsewhere in this issue. Buettner’s common sense advice: “Sit down with a plant-based cookbook, identify a dozen recipes that you think your family would enjoy and cook them instead of going on a diet or spending money on a program. Also, eliminate soda pop, one of the unhealthiest parts of the American diet.”
Eat until you’re 80% full. “And have your biggest meal first,” advises Buettner, “eat breakfast like a king, lunch like a prince and dinner like a pauper.”
Family-first focus.
Belonging: feeling connected to your community.
Right tribe: surrounded by friends who support healthy behaviors.
Natural movement throughout the day.
Strong sense of purpose.
Ability to de-stress.

Joint Assets: An Osteoarthritis Update

The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered a “wear and tear” condition, associated with aging. It was thought that cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving. New research shows that it is a disease of the entire joint that also causes bony changes of the joints, deterioration of tendons and ligaments and inflammation of the synovium (lining of the joint). While more prevalent in people over 50, OA can show up in younger patients, especially those who’ve experienced a joint injury such as a torn ACL or meniscus. The promising news is that according to the Arthritis Foundation, “OA is not an inevitable aging disease” and the Cleveland Clinic notes: “Age is a contributing factor, although not all older adults develop osteoarthritis and for those who do, not all develop associated pain.”

Still, currently OA is by far the most prevalent form of arthritis, affecting more than 32.5 million Americans, and primarily targeting knees, hips, hands and spine. A variety of factors contribute to the development of OA, including congenital joint deformity, family history, previous joint injury, and years of physically demanding work or contact sports. However, reducing risk is possible with attention to these modifiable factors:

Obesity adds stress and pressure to joints. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably – losing one pound takes 3 pounds off the knees.
Lifestyle. Being physically active is crucial, as a sedentary lifestyle and obesity are associated with a higher risk of OA. While sports such as football, baseball and soccer may pose a risk because of their impact on joints, most types of regular or moderate exercise can be safely done.

Living with Osteoarthritis

Unfortunately, there is no cure for OA, and managing symptoms such as joint stiffness, tenderness, swelling, and popping or crackling can become increasingly difficult over time. While seeking a pill to alleviate discomfort is a natural reaction, consider trying alternative solutions to help break the cycle of chronic pain.

“The longer the brain processes pain, the more hypersensitive it becomes to pain,” explains Rachel Welbel, MD, a physiatrist who is extensively trained in physical medicine and rehabilitation and sports medicine. “The brain, now constantly on high alert, may respond to non-painful sensations as if they are painful. Poor diets and stress can increase chemicals in the brain that reinforce this response, prolonging the pain cycle.”

Reflecting a more holistic and multi-faceted approach to managing pain, she says: “Opioids are almost never the answer.” Instead, she recommends lifestyle modifications, treatments and medications that help tackle pain in a variety of ways.

Lifestyle Modifications, Treatments and Medications for Osteoarthritis

Weight management. Obesity is not only a leading risk factor for OA, but adds to the pain for those with the condition. Body fat produces proteins called cytokines that cause inflammation, and in the joints, can alter the function of cartilage cells. Shedding even a few pounds can make a difference: losing just 10% of your body weight can cut arthritis pain in half, and losing another 20% can reduce the pain by an additional 25% or more, and may slow or even halt progression of the disease.

Exercise and movement. “Exercise is key to living well with OA,” says Welbel. “While resting aching joints may bring temporary relief, lack of movement ultimately leads to more discomfort. The focus is not on weight loss but on minimizing pain and maximizing strength.” Plan on 150 minutes of light to moderate exercise each week. She recommends working with a physical therapist who can analyze your joint biomechanics and suggest exercises to strengthen muscles and improve range of motion while reducing stiffness and pain. “In addition, exercise is a natural mood elevator,” says Welbel. “Walk, swim, or try mindfulness-based, stress-reducing exercise such as yoga and tai chi.”

Anti-inflammatory diet. Increasing consumption of fruits, vegetables, whole grains, legumes and fish, while reducing consumption of red and processed meats, refined grains, and sugar-containing beverages and foods, may play an important role in reducing pain associated with inflammation from OA, says Welbel. Try incorporating into your diet fatty fish; herbs and spices such as garlic, turmeric and cinnamon; yogurt and other fermented foods; and healthy fats such as avocados, extra virgin olive oil and walnuts.

Supportive devices. A cane or walker can help lighten the load on your joints, decrease pain, and reduce your risk of falling. Intermittent use of a knee brace may be helpful for added stability, especially if walking on uneven surfaces. Foot orthotics such as arch supports and metatarsal pads may reduce foot pain.

Medications. Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) may help joint pain and stiffness for some. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also used to relieve pain, including OTC medications such as Advil or Aleve, or Celebrex, a prescription medication with a somewhat lower risk of ulcers and upper gastrointestinal bleeding than other NSAIDs. Topical NSAIDS such as Aspercreme and other creams or patches containing ingredients such as capsaicin, menthol or lidocaine can help.

Injections. Corticosteroids injections may provide temporary relief for acute flare-up of OA pain in knees and finger joints, but effectiveness can vary, and you must wait at least 3 to 6 months to repeat an injection in a specific joint if needed. Viscosupplementation involves injection of a gel-like substance containing hyaluronic acid, which acts as a lubricant in the fluid between bony surfaces and is decreased in OA joints. Research results for significant pain reduction or improved function are not yet convincing, but there appear to be a number of patients with mild to moderate knee OA who report symptom relief.

Supplements. Research results are mixed, but we note some of the more well-known supplements with the caution that these are not recommended to be used alone as treatments for OA. Glucosamine and chondroitin sulfate, naturally occurring compounds found in healthy cartilage, may help reduce joint pain and stiffness, and have been available in the U.S. and Europe for several decades. Other supplements such as tart cherry and turmeric may help reduce OA symptoms for some.

Other promising but not yet proven treatments. Platelet-rich plasma (PRP) injections and stem cell therapy have been used to treat pain of mild to moderate knee OA, but evidence of effectiveness is mixed, and these are still considered experimental. Elements of Eastern medicine, including herbs and acupuncture, may help control OA symptoms, but have not yet been confirmed in large clinical studies.

A Generation of Joint Replacements

When diet and exercise modifications, supportive devices, medications and injections no longer sufficiently ease the pain of OA, a hip or knee replacement may be recommended. The number of people opting for this surgery increases each year, now totaling more than 790,000 knee and 450,000 hip replacements annually.

The implants, made of plastic, metal or ceramic, are traditionally kept in place with bone cement, which is gradually being replaced by newer cementless and porous titanium systems to improve bone fixation and durability. Also on the rise is computer-assisted surgery to increase placement accuracy of the prosthetic components, and patient-specific implants using 3D printing technology. The combination of modern materials and advanced surgical techniques have extended the durability of most implants to 20 years, a marked improvement over the previous standard of 10 to 15 years.

Recovery time has also changed for the better. With rehabilitation to regain strength and motion, normal activities can usually be resumed within weeks to months. Most importantly, the majority of patients are highly satisfied with the results, reporting minimal to no pain and significantly improved function and quality of life. However, outcomes can vary and potential complications should be discussed before proceeding.

Additional breakthroughs may be on the horizon: researchers at Duke University start trials this spring of a hydrogel-based cartilage substitute that may prove more durable than natural cartilage…stay tuned!

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.

Bone Up: What Is Osteoporosis?

Except for dedicated thespians, saying “break a leg” is most definitely not a harbinger of good luck. More than 10 million Americans are living with osteoporosis, a condition of low bone mass that results in increased risk of bone fracture, sometimes even from a minor fall or pressure from a big hug. Over 1.5 million osteoporotic fractures occur annually, and 1/3 of women and 1/5 of men over 50 will experience an osteoporotic bone fracture in their lifetime. The good news is that reliable diagnostic testing and treatments are available, which we share below.

Who’s at Risk for Osteoporosis?

Osteoporosis is sometimes referred to as a “silent disease” because it is painless unless a fracture occurs, so people often are unaware they have it until that happens. Post-menopausal women are at highest risk, in part due to the decline in estrogen levels. Estrogen, and to an even greater extent, testosterone, are hormones that help ward off osteoporosis, which is why it is not as common in men. Others at risk include those with autoimmune diseases such as rheumatoid arthritis and celiac disease, those with high parathyroid or thyroid levels and certain other chronic diseases.

Medications including corticosteroids, proton pump inhibitors and certain antidepressants and anti-seizure medications may increase risk of bone thinning. Inherited factors may affect risk, such as race (more common in Caucasians and Asians), body shape and size (smaller/thinner individuals more at risk) and family history of osteoporosis. Physical activity level and diet play a role, placing those who are sedentary and/or have a diet low in calcium at higher risk. Cigarette smoking and higher alcohol intake are also risk factors.

How Osteoporosis is Diagnosed

A bone density measurement test is the best way to diagnose osteoporosis, using the DEXA (dual energy x-ray absorptiometry) scan of hip and spine. The severity of decrease in bone mass is determined by your T-score: Between -1.0 and -2.5 is defined as osteopenia, when bones are weaker than normal, while -2.5 or less indicates osteoporosis.

Osteoporosis Medications

A number of medications are available to treat osteoporosis.

Bisphosphonates to slow the breakdown and removal of bone are typically tried first. Fosamax, used most, is a weekly pill often taken for 5 years followed by a “drug holiday.” The IV bisphosphonate Reclast is generally continued for three years.
Evista is a daily pill for post-menopausal osteoporosis that protects against bone loss and also reduces the risk of breast cancer in high-risk women.
Prolia is injected every 6 months to slow breakdown and removal of bone and help increase bone density. It should not be discontinued once started or must be followed by another medication if stopped.
Evenity is injected once a month for a year to increase new bone and reduce breakdown and removal of bone.
Forteo and Tymlos are drugs that help build bone for people at high risk of fracture. These are injected daily for two years.

Managing Osteoporosis

Peak bone mass is achieved by age 25-30 years, but at any age, a healthy lifestyle can aid in strengthening bones. Focus on eating a balanced diet rich in vitamin D and calcium (see sidebar), and remember that exposing the body to natural sunlight increases production of vitamin D. Eliminating tobacco use and limiting alcohol is strongly recommended to promote maximum absorption of calcium and vitamin D. Taking fall prevention measures is crucial: consider that 95% of hip fractures are caused by falls.

Aim for 30 minutes of weight-bearing and muscle strengthening exercises on most days:

Walk or run on level ground or a treadmill
Dance
Climb stairs
Lift weights without straining your back
Sit-to-stand exercises: start with an elevated seat height, and progress to a lower chair as you get stronger
Strengthen thighs: stand against a wall and slide down into a slight knee bend, hold for 10 seconds and repeat a few times
Tai Chi: combines slow movements, breathing exercises, and meditation

Nourishment Know-How for Bone Health

For optimal bone health, a daily intake of 1200-1500 mg of calcium and 400-800 IU (international units) of Vitamin D is recommended for adults. In many cases, supplementation may be appropriate.

Selected sources with calcium and/or Vitamin D:

Dairy products
Calcium- and vitamin D-fortified foods and beverages (soy or almond milks, cereals, cheese)
Dark green, leafy vegetables
Fish such as salmon, trout, mackerel, tuna, sardines
Egg yolks
Sesame or chia seeds, figs, almonds

Fall Prevention Measures for Those with Osteoporosis Include:

Avoid ladders, step-stools and roof work
Eliminate tripping hazards like throw rugs, obstacles or cords on the floor
Be careful around pets and leashes
Use good lighting, night lights, update glasses and eye care to optimize vision
Stay fit with regular strengthening and balance exercises
Wear non-slip shoes
Install handrails and grab bars in the bathroom

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Studying the Secrets of Super Agers

The growing group of people able to enjoy 100 years of life may well be one of the most remarkable achievements of the 21st century. A generation ago, the number of centenarians worldwide was just 110,000; today they are 600,000 strong. Notably, a sizable segment of this long-lived group, aptly called Super Agers, reach 100 in good health with no age-related disease or disability. Are they the fortunate recipients of outstanding genes, followers of a particularly healthy lifestyle, or a combination of both?

Definitive answers may start to emerge sooner than we had imagined possible, thanks to the SuperAgers Family Study, called one of the most ambitious ever conducted, with the goal to uncover and understand the genetic and biological mysteries of exceptional longevity and healthy aging. The initiative, spearheaded by the American Federation for Aging Research (AFAR) and Albert Einstein College of Medicine, in collaboration with https://www.bumc.bu.edu/busm Boston University School of Medicine, will recruit 10,000 people over age 95 to collect their DNA samples and health histories, as well as their children’s.

“Super Agers show us that chronic disease is not an inevitable part of aging, and that an extended period of good health can accompany a long lifespan,” says Sofiya Milman, MD, principal investigator of the study and director of Human Longevity Studies at Einstein’s Institute for Aging Research.

While previous research has attempted to pinpoint the distinctive characteristics of people living well in their ninth and tenth decades, the enrollment of 10,000 participants in SuperAgers will represent the largest cohort ever studied. The extensive numbers are essential to obtaining meaningful data that can benefit many in the future, according to Milman.

“We believe longevity may be linked to rare genetic variants found in less than five percent of the population, making it a challenge to amass ample genetic evidence,” explains Milman. “The enormous data bank being built in our SuperAgers study will enable us to identify these genes, understand their biological pathways and explore how to duplicate their functions.”

Milman aims to achieve full enrollment over the next two to three years, with results from the first phase available in 2024. “SuperAgers will significantly accelerate our research by providing us with a treasure trove of data on not just genetics, but biological and behavioral factors that affect aging and its related diseases. Ultimately, this will help us develop, trial and fast-track new therapies to extend a healthy old age,” she says.

In the meantime, adhering to a nutritionally balanced diet, exercising, getting sufficient sleep, managing stress and eliminating tobacco are all well advised. “A healthy lifestyle alone may not be enough to guarantee you reach 100,” admits Milman, “but all evidence points to the fact that it will extend your healthy lifespan.”

SuperAgers Sign-Up

Interested in being part of the SuperAgers family study?

Individuals who have passed their 95th birthday, as well as children of those individuals, are invited to enroll online at http://www.superagersstudy.org and complete a health history, family history and demographic profile. Those eligible will receive a biospecimen collection kit in the mail and are asked to return it in a postpaid envelope to the Albert Einstein College of Medicine, which will store and process each participant’s DNA. Please note that participants may choose to receive results regarding their ancestry or family origins. The SuperAgers biobank holding the DNA records, and all the related data, will be protected and maintained at Einstein in compliance with federal medical privacy law (HIPAA).

Dementia and Alzheimer’s: Updates from a Leading Geriatrician

Senior Moments Or Something More?

As Baby Boomers continue the inexorable journey deep into their senior years, preserving cognitive function understandably tops the list of worries. While Alzheimer’s Disease and related dementias are seen in just 5% of people over 65, that number jumps to 30% for people age 85 and over. Questions abound: is forgetting a name a sign of normal aging or an indicator of a more serious memory disorder? Are any nutritional supplements or pharmaceutical treatments available that are proven to stave off memory loss? Most importantly, what steps can be taken to modify individual risk?

To better understand how to identify and manage dementia and Alzheimer’s disease, we asked one of the country’s leading experts, R. Sean Morrison, MD, for his informed perspective on this growing concern for seniors, their families and caregivers. A practicing geriatrician, palliative medicine physician and health researcher for almost three decades, Dr. Morrison has earned numerous awards and recognition for his work, and currently serves as the Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and as Director of the Hertzberg Palliative Care Institute.

Is memory loss an inevitable, natural sign of aging?

Dr. Morrison: The good news is that not all cognitive functions decline with age. The ability to maintain attention, language comprehension, usage, and vocabulary does not decrease. Knowledge learned years ago like how to ride a bike, or brush your teeth, also stays intact. Additionally, when you learn something new and can remember it, you won’t forget it any more rapidly than when you were younger.

The not so good news is that it will take greater effort to learn those new things; more attention, repetition and use of memory-enhancing strategies will be needed. The ability to multitask is also diminished, as processing information takes longer and reaction times are slower. People may experience poorer performance when working under time pressure, and find it more difficult to manipulate information in the brain, such as calculating a tip in a restaurant or figuring out a route to travel from one place to another.

How do you distinguish between a “senior moment” lapse in memory and a sign of Alzheimer’s disease?

Dr. Morrison: So many people experience that temporary inability to remember a name. But if you are able to recall things with a cue or can pick it out from a list of possibilities, that’s evidence of a problem with retrieval but not with storage. You can be reassured that it doesn’t indicate Alzheimer’s disease but a “senior moment” because the information has been successfully stored in your memory.

Is routine screening for dementia recommended in older adults?

Dr. Morrison: The U.S. Preventive Services Task Force does not recommend for or against routine screening, saying no interventions are proven to have a significant effect in people with earlier detected cognitive impairment. However, it is required as part of Medicare’s yearly assessments, and most primary care physicians consider dementia screenings an essential part of their annual wellness exam.

What types of screening tests do you recommend?

Dr. Morrison: At least a dozen tests are available, each with their own benefits and drawbacks. I recommend the following for their ease of use and proven sensitivity and specificity in diagnosing cognitive impairment:

Mini-Cog is a quick, three-minute evaluation. Patients are asked to repeat three words, draw a clock with hands at a specific time, and then recall the initial three words.
Memory Impairment Screen assesses free and cued word recall. Patients are read four unrelated words from four categories (e.g. Red Cross, saucer, checkers, telegram) and after a few minutes of diversion, asked to recall the words in 20 seconds, either with no prompting or cued by category.
Animal Fluency Test. Patients are asked to name as many animals as possible in a 60-second period.

Are there any risk factors for dementia and Alzheimer’s disease that can be controlled by patients?

Dr. Morrison: Quite a few risk factors are modifiable with lifestyle changes and non-pharmaceutical treatments. These include:

Address hearing and visual impairments, with eyeglasses, hearing aids and other assistance
Prevent and manage hypertension and diabetes
Maintain a healthy weight
Stop smoking
Seek treatment for depression
Prioritize regular exercise and physical activity
Avoid social isolation
Explore cognitive training

The best advice I can give to people in their 50s to 70s looking to prevent or delay progression of dementia and Alzheimer’s disease: exercise, exercise, exercise and rigorously control your blood pressure.

How are the symptoms frequently experienced by people with dementia – sleep disturbance, mood disorders, agitation – best addressed?

Dr. Morrison: There are a number of non-pharmaceutical interventions that have proven effective. Use adaptive clothing and assistive devices to help eliminate distress around bathing and dressing. Create a reassuring familiar structure to the day with a regular routine and activities. Optimize the sleep environment with a comfortable temperature, the right amount of light, a warm milky drink and a bath or shower before bed; avoid stimulating medications, drinks containing caffeine and alcohol, and exercise too close to bedtime. Pharmaceutical treatments can also be considered, including antidepressants to improve cognition and ameliorate agitation and aggression, and melatonin and melatonin antagonists to help with sleep disorders. Of note: medications such as benzodiazepines (BZD), non-BZD hypnotics, mood stabilizers and antipsychotics are no longer routinely recommended as side effects can outweigh possible benefits.

Are there any benefits to nutritional supplements or appetite stimulants?

Dr. Morrison: Nutritional supplements can help with weight gain in patients with anorexia or cachexia (‘wasting’ syndrome) but have no meaningful impact on survival. And while appetite stimulants such as cannabinoids and steroids are often given to help patients with dementia, there is no consistent data regarding their safety and efficacy.

What medications are available to treat or stop the progression of dementia?

Dr. Morrison: Until last year, only four medications were approved for treatment of dementia and Alzheimer’s disease, showing only a minimal to modest improvement in cognition. In 2021 a fifth drug was launched – aducanumab – a monoclonal antibody designed to reduce amyloid protein in the brain. Its fast-track approval was quite controversial as the clinical benefits of the drug were not proven during trials, which were stopped early as a result, and some severe side effects were observed. Interestingly, some researchers are now rethinking the idea that targeting amyloid protein plaques will eliminate Alzheimer’s disease, and instead exploring Alzheimer’s as a disease of inflammation. This could be the next fascinating line of research.

How a Memory is Made

Memory begins to form by giving attention to the information received through your senses. Anything that interferes with your ability to pay attention, such as hearing impairment, will affect the formation of a sensory memory. Successful integration of sensory memories into your working memory enables you to temporarily store, organize and manipulate information. These memories are then encoded into long-term memory and finally put into permanent storage.

In a Pickle and Looking for a New Summer Activity?

Try Pickleball, the Country’s Fastest-Growing Sport

Tired of the same ‘ole routine every summer but find yourself in a pickle and looking for a new summer activity? Well, according to American Council on Exercise (ACE), you might want to consider pickleball.

As everyone from your next-door neighbor to ACE will attest, pickleball is extraordinarily popular. Its rapid rise to ubiquity can be attributed to a number of factors, ranging from easily learned rules and minimal equipment needs to intergenerational appeal and abundant opportunities for socializing.

This blend of badminton, tennis and table tennis can be adjusted to suit the intensity and competitiveness of the players, making it simple enough for beginners but fast-paced enough for more fit or skilled participants.

All of which is to say that if you haven’t yet considered picking up a pickleball paddle and the light, whiffle-like plastic ball, summer 2022 might be the perfect time to do so.

“Pickleball doesn’t require the skill of tennis, so it is easily adapted by most, and provides all the benefits of movement, including calorie burning and enhanced functional capabilities,” says Dr. Cedric Bryant, ACE president and chief science officer.

Already a favorite sport in retirement communities, pickleball has swelled to include more than 4.8 million players in the U.S. – almost double the number from five years ago – earning it the title of fastest-growing sport in 2021 and 2022. According to the Sports and Fitness Industry Association, the spike has been fueled by people ages 54 and younger looking for a friendly yet competitive and lively sport.

“People who play are generally having so much fun they don’t realize how much exercise they’re actually getting,” says Laura Gainor, spokesperson for the USA Pickleball Association.

At 44 x 20 feet, the pickleball court is one quarter the size of a tennis court, so it’s easier to keep the ball in play and achieve a brisk workout. According to ACE, pickleball may provide just what many middle-aged and senior adults are seeking – a safe and effective workout that yields long-term benefits and encourages lifelong participation.

A small research study recently conducted by the organization among people ages 40 to 85 showed that playing four 15-minute pickleball matches three days each week meets exercise intensity guidelines for improving and maintaining cardiorespiratory fitness. Study authors reported the positive impact on cardiometabolic risk factors, with participants experiencing favorable changes in cholesterol levels, systolic and diastolic blood pressure, and peak oxygen uptake after six weeks.

The smaller court also benefits older people or those who have problems with their joints, because less running is needed, resulting in less wear and tear on the joints. One cautionary note: Experts advise learning proper technique to prevent falls. As always, be sure to check with your healthcare provider before beginning any new physical activity.

“Take a few lessons to get started, and you’ll quickly ramp up,” assures Gainor. “After three to five games, you’ll have a very good understanding of how to play, and will become addicted to it shortly after!”

Take It Outside: Keep Moving This Summer

There’s no one-sport-fits-all approach, so if pickleball doesn’t appeal, find your inspiration in one of these activities, spanning the spectrum from low exertion to highly energetic:

Stroll through farmers’ markets or art fairs
Go produce picking at a local orchard
Forest bathe – immerse yourself in nature at a forest preserve
Gardening – remember to bend from your knees and waist rather than your back
Swim – use a variety of strokes to limber up your whole body
Disc golf – a low-impact way to challenge your coordination
Yard yoga – take your mat and routine outdoors
Hike, jog, run or cycle on an outdoor trail
Kayaking – for a vigorous upper body workout
Stand-up paddleboarding or Boga – challenging, board-based water workouts

Sources: American Council on Exercise, American Heart Association, USA Pickleball Association

When Are the Best Years of Our Lives?

Life’s Happiness Continuum Is there a predetermined peak age for happiness, before which our normal outlook is gloomy and melancholy and after which we slump back into these non-euphoric ways? When Are the Best Years of Our Lives? Studies Show Two Stages of Life Happiness Like trying to define why some people are born to...

The post When Are the Best Years of Our Lives? appeared first on Specialdocs Consultants.

1 2 3 »

Archive For: Healthy Aging

Ageism: A Mental and Physical Toll

The Power of Positive Aging

Challenging the Aging Myth

Changing the Conversation Around Aging

When to seek help for mental health

Anxiety

Depression

The Popularity of Hormone Therapy for Menopause

Depression and Menopause

A Healthy Lifestyle to Mitigate Menopause Symptoms

Eight Lessons from the Blue Zones

Eight Lessons from the Blue Zones

Living with Osteoarthritis

Lifestyle Modifications, Treatments and Medications for Osteoarthritis

A Generation of Joint Replacements

Who’s at Risk for Osteoporosis?

How Osteoporosis is Diagnosed

Osteoporosis Medications

Managing Osteoporosis

Nourishment Know-How for Bone Health

Fall Prevention Measures for Those with Osteoporosis Include:

SuperAgers Sign-Up

Senior Moments Or Something More?

Is memory loss an inevitable, natural sign of aging?

How do you distinguish between a “senior moment” lapse in memory and a sign of Alzheimer’s disease?

Is routine screening for dementia recommended in older adults?

What types of screening tests do you recommend?

Are there any risk factors for dementia and Alzheimer’s disease that can be controlled by patients?

How are the symptoms frequently experienced by people with dementia – sleep disturbance, mood disorders, agitation – best addressed?

Are there any benefits to nutritional supplements or appetite stimulants?

What medications are available to treat or stop the progression of dementia?

How a Memory is Made

Try Pickleball, the Country’s Fastest-Growing Sport

Take It Outside: Keep Moving This Summer

Learn more about Personal Medical Practice services with Marc Spero, MD.