Healthy aging is not the simple absence of disease in the age group above 65. It is a set of habits and behaviors to be implemented at the age of 40 and beyond if we want to keep an active, independent lifestyle in the geriatric population. Adequate physical activity, heathy nutrition, use of preventive services, judicious use of medications and awareness of mental health problems are areas that merit special attention.
Physical activity is crucial in the prevention of myriad diseases, in lessening the impact of chronic illnesses and in alleviating mental health problems. Brisk walking for a total of 30 minutes per day should be enough in meeting these goals. If the weather is prohibitive, walking in an air conditioned mall or spacious grocery store is a good alternative. In a subset of patients with osteoarthritis of the knee and hip, biking (stationary bike at home or road bike) as well as swimming will allow physical activity without putting weight on these joints. Weight-bearing activities may enhance the wear and tear in these joints.
The 30 minutes of total daily activity can be divided between two sessions of 15 minutes each or even three sessions of 10 minutes each. Brisk walking entails the feeling of your heart pounding when walking, so a tailored rapid pace is required to achieve the cardiac workout we are aiming for. Especially in women, weight-bearing exercises are a key component in bone health and prevention of osteoporosis.
Nutrition is essential to maintain adequate micronutrients and macronutrients intake. It is important to achieve optimal weight while avoiding unhealthy components of modern diet, such as processed meat, soft drinks, trans fat and high-fructose corn syrup. A healthy meal consists of one half fruits and vegetables, one quarter carbohydrates (bread, pasta, rice, potatoes) and one quarter protein (lean meat, chicken, fish, eggs) together with one serving of low-fat dairy products (milk, yogurt, cheese). Adequate fluid intake is essential for bowel and kidney functions and that intake should be increased in hot weather or with strenuous activity. A low salt, high potassium, high magnesium diet will help maintain blood pressure within normal range.
Preventive services, mainly screening for colorectal cancer, breast cancer, cervical cancer and timely vaccination, should be sought. Screening for colorectal cancer is recommended starting at the age of 50, and possibly 45. Options for this include colonoscopy or different stool tests. Colonoscopy should be repeated every 10 years in low-risk individuals with no prior history of colonic polyps or cancer. Stool testing can be repeated every one to three years depending on the type of test.
Screening mammography should begin at the age of 40 to 50 and repeated every one to two years in low-risk females. Cervical cancer screening with Pap smear is recommended every five years after the age of 30. Yearly flu vaccine for all age groups and killed Zoster vaccine starting at the age of 50 also are recommended. Lastly, screening for osteoporosis with DEXA scan (dual energy x-ray absorptiometry) is recommended in women at the age of 65. Smoking cessation is highly recommended, and excessive use of alcohol (more than seven cans of beer weekly in women and 14 cans weekly in men) should be discouraged.
Continuous and regular use of medications such as benzodiazepines and narcotics should be avoided. These medications will cause dependence, can be potentially abused, can increase the risk of falls, worsen memory problems and, in the case of opioids, are linked with hypogonadism in males. Recent studies have shown that opioids have no or very limited role in chronic non-cancer pain. Prolonged use of non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen and high-dose aspirin can lead to peptic ulcer, gastrointestinal bleeding and increases the odds of having acute and chronic kidney disease. They can also lead to hypertension and fluid retention, both predisposing factors for the development of heart failure.
Prevention of social isolation and regular interaction with family and friends is helpful in the prevention and management of mental health problems such as depression and anxiety. Psychotherapy, mainly cognitive behavioral therapy and occasionally psychoactive drugs may be needed in severe cases. Abrupt discontinuation of antidepressants should not be done. Non-adherence to antipsychotics in the case of schizophrenia or mood stabilizers in the case of bipolar disorder also should be avoided.
Emad Shoukry, MD, is a board-certified gerontologist who practices at the Louise H. and Joseph Z. Ornelas Center for Healthy Aging at UT Health North Campus Tyler. To schedule an appointment with Dr. Shoukry, call 903-596-DOCS.