The Jewels in the Crown

The diamond Queen

Lucien Freud Portrait

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

George IV diadem

Long lived diamonds

Even she gets a senior moment

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

IDT 10

Successful aging

They are not the only ones

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

The Rectangular Survival Curve

IDT May 20101504/18/23

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

The Gold of Exercise

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

Weight bearing exercise

• May slow the rate of bone loss

• Improve muscle strength

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

Get a pet

IDT 30

Walking

Pearls of Diet

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

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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

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Artist Chris LevineAspreys Crown Jewellers

Diamonds of Social Interaction

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

Importance of Family Life

IDT 44

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

Spirituality

IDT 49

The Black Prince’s Ruby

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

IDT 59

Brain exercise She even works on Christmas Day

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

Successful agingthe other 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