Integrative Medicine Part IV - Preventive Aging

Does old age necessarily mean declining health and cognition or can one age gracefully with a high quality of life?  

This was another topic discussed at the recent Health and Wellness conference organized by the University of Maryland Center for Integrative Medicine.  Steven Gambert, MD, Professor of Medicine and Surgery and Director of Geriatric Medicine at the University of Maryland Medical Center described preventive aging. Here are my notes from his talk with some personal observations added in. 

America has a rapidly aging population. In 1900 only 4% were over age 65 and 1% over 75 years. By 1950, it was 8% and 2.6% respectively and by 2000 it was 13% and 5% with these expected to grow to 21% and 8% by 2030. In absolute numbers, there are now about 12 million over the age of 80; a doubling since 1957. Older people run the full gamut from the very healthy, to those with a few health issues, to those with multiple problems to the very frail. Frail individuals (see my earlier post of frailty) have a high risk for poor outcomes of any illness, slower recovery and heightened mortality. So the agenda, of course, is to stay as healthy as possible throughout your later years.

Can you do anything to prevent illness? Can you embark on a “preventive aging program?” The answer is definitively “yes” and it is never too late to get started. But just like saving up for retirement, it’s best to begin at an early age so that the value can compound through the years.  

The first major element of the preventive aging program is to prevent an acceleration of the normal aging process. Most physiologic functions begin a slow but steady decline beginning at about age 30 to 35. This includes our bone density, kidney and lung function and cognitive skills. Some decline is inevitable but the process can be slowed. There are four basic steps.  

In no particular order the first step is to avoid environmental risk. It is never too late to stop smoking and so reduce the risk of lung cancer and other cancers but also to slow the decline of general lung function. Noise is an environmental hazard. Hearing declines with age and noise rapidly accelerates that decline. Loud music and loud restaurants are best avoided despite our current cultural attractions to both.  

The second step is proper nutrition. Eating foods with a wide mix of vitamins and minerals, high quality protein in sufficient quantity, good oils and fats and lots of fiber is of critical importance. Vitamin and mineral supplements are still valuable but they should be just that – supplements – not the prime source.  

The third step is exercise. Our muscles were meant to be used and we need to do just that. A regular regimen of moderate aerobic exercise such as walking for 30 minutes each day can’t be beat. Add to that some weight bearing exercise (probably at a gym or similar facility) three times each week to maintain and build strength. And remember to do both range of motion such as simple stretching or adding in yoga and balance exercises regularly.  

The fourth and very critical step to prevent acceleration of normal aging is to exercise your brain. Do some activities that challenge your mind – Sudoku or chess does that; watching TV definitely does not!  

Following these four steps can dramatically slow the aging process but you next need to prevent age prevalent diseases. Here again the best time to do this begins when you are young. The leading causes of death in the elderly are heart disease, cancer and stroke – no surprise here. Each of these are largely but not entirely preventable by attending to our lifestyles. Unfortunately most Americans eat a non-nutritious diet and too much of it, don’t get enough exercise, are chronically stressed and 20% smoke. The result is a population which is obese, with high blood pressure, an actual developing epidemic of diabetes and over time a high incidence of heart disease, cancer and stroke. So it behooves us to address our lifestyles beginning at whatever age we may be today and following though over the years.  

In addition older people should be sure that their immunizations are up-to-date such as annual influenza in addition to the pneumonia vaccine and shingles vaccine but also the less commonly paid attention ones such as tetanus and diphtheria. And as already suggested, avoid high noise environments, eat a good diet, get regular exercise and use your brain regularly.  

Part of healthy living includes adequate sleep. It’s simply not true that older people need less sleep. It is true that older people don’t sleep as well or as soundly and may need naps.  

Stress reduction (see a later post in this series for more information) in this hectic world is equally important. Seek ways to reduce this burden with tools such as meditation, mindfulness training, yoga, etc. Exercise can in itself be a great way to reduce stress and may have an impact on our own endogenous neurotransmitters to alleviate stress. 

Finally healthy aging also requires social contact. A good social life is actually critical to healthy aging. It will “add life to your years.”  

Aging gracefully is discussed in more detail in the last chapter of my book The Future of Health Care Delivery – Why It Must Change and How It Will Affect You. 

So it is possible to age gracefully with good health. Starting the process when you’re young makes it all that much more effective. But it is never too late to get started. It’s possible to just die of “old age” rather than one of the common chronic illnesses that are today’s plagues.  

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