Physical Dimensions of Healthy Aging

1. Physical Dimensions of Healthy Aging Ellen F. Binder, MD Division of Geriatrics and Nutritional Science ebinder@wustl.edu

2. Disclosures of Interest Research Support: • National Institute of Mental Health • National Institute on Aging Consulting • Eli Lilly, USA I own no stocks or equity in any pharmaceutical company.

3. “Yet another national placing for Lavelle Kelly” Tillamook Headlight Herald April 11, 2006

4. What Defines Healthy Aging? • Absence of major disease • Absence of disability Defined as inability or great difficulty with ADLs or mobility

5. Significance of the Problem • U.S. population > 65 yrs. expected to grow to 20% by 2030 and continue to increase until 2050. • 40% of the older adult population has some disability or dependency. Such individuals are at high risk for recurrent hospitalization, injurious falls, NH placement, and death. • The prevalence of chronic disability is higher in older women than among men. • Although women have a longer total life expectancy they are likely to spend more years than men in a disabled state, even among those with severe disability.

7. Disabled Population & Rates NLTCS 1982-2004

8. Risk Factors for Disability in Older Adults • Lifestyle and health habits • Physiologic changes associated with aging • Diseases/Conditions • Social factors • Economic factors

9. Physiologic Changes Associated with Aging • Hormonal • Body composition, energy intake, and lipids • Cardiovascular and pulmonary • Renal (kidney) • Hepatic (liver) • Sensory • Cognitive/Neuro-motor

11. Changes in Aerobic Power with AgeWomen vs. Men From Holloszy & Kohrt in Handbook of Physiology-Aging, 1995

12. Diseases/Conditions Associated with Disability in the Elderly • Vascular disease (heart, brain, arteries) • Arthritis • Lung Disease (Asthma, COPD) • Depression • Dementia • Cancer • Diabetes • Malnutrition / Obesity • Falls • Incontinence • Polypharmacy

13. Prevalence of Geriatric Impairments by Age Group from CHS Chaudhry et al. JAGS 58: 1686-92, 2010

14. Risk of Disability Onset over 7 Yrs. From Chaudhry et al. JAGS 58: 1686-92, 2010

15. Predictors of Healthy Aging in CHS • Absence of Hypertension/Lower BP • Lower Waist Circumference (non-obese) • Higher HDL Cholesterol • Absence of diabetes • Regular exercise, especially higher intensity • Moderate intake of wine • Lower clotting factors • No cigarette smoking • No regular ASA use • Stable financial status

16. Predicted Median Life Expectancy by Age and Gait Speed Studenski, S. et al. JAMA 2011;305:50-58

17. Exercise Can Reverse Disability Risk in Older Adults • Muscle strength and power • Body composition, lipids, weight • Aerobic Power • Gait speed • Balance • Flexibility • Bone Density • Mood and Psychological Well Being • Falls

18. Components of “Best Practice” Physical Activity Programs • Attention to health education & exercise “readiness” • Accessibility • Tailoring of the exercise program to physical ability and preferences • Multi-component exercises flexibility, aerobic, strength training • Multiple sessions per week (≥3) • Ongoing social support • Ongoing feedback

19. Components of Success for Community-Based Programs • Collaboration with community agencies and organizations. • Use of existing programs and infrastructure. • Promotion as a social program. • Planning for wide variability in functional ability. • Use of an expert advisory board.

20. Successful Community-Based Health Promotion Interventionsin Older Adults • Multi-component falls prevention • Vitamin D replacement Potential Areas (not disease-specific): • Medication education and compliance • Nutrition and weight management

21. Questions???

22. From Fried et al. J Gerontol Med Sci 561:M146-156, 2001