AN OVERVIEW OF OPTIMAL AGING

1. AN OVERVIEW OF OPTIMAL AGING Carol L. Monson, DO. MS. FACOFP, FAAFP Family and Community Medicine MSUCOM

2. OPTIMAL AGING OBJECTIVES • Define the Philosophy of Optimal Aging • Compare philosophy of optimal aging with the philosophy of Osteopathic Medicine and Successful Aging • Describe the determinants of optimal aging • Discuss the components of optimal aging • Describe the effects of positive and negative attitudes on health

3. OPTIMAL AGING Optimal Aging The capacity to function across many domains—physical, functional, cognitive, emotional, social, and spiritual – to one’s satisfaction and in spite of one’s medical conditions Bates & Bates (1990) Walsh (1993) Kenneth Brummel-Smith MD (2007)

4. OSTEOPATHIC MEDICINE Principles of Osteopathic Medicine “To find Health should be the object of the doctor... Anyonecan find disease.” Andrew Taylor Still, MD, DO (1899)

5. OSTEOPATHIC MEDICINE Principles of Osteopathic Medicine Osteopathic medicine views the human being as a unit of body, spirit and mind in which structure and function are interrelated or integrated (Multiple authors interpreting A.T. Still)

6. OSTEOPATHIC MEDICINE The human being has self-regulatory mechanisms and is able to defend and heal itself. When the normal homeostasis of the human being is altered, then this being becomes susceptible to disease, and treatment must occur.

7. SUCCESSFUL AGING Absence of disease and disability; high cognitive and physical functioning; and active engagement with life Rowe and Kahn (1997)

8. OPTIMAL AGING Determinants of Health • Function • Disease • Social environment and support system • Physical environment • Genetic endowment • Individual responses – behavior & perspective • Healthcare system

9. OPTIMAL AGING Components of Optimal Aging- Body • Biological - Exercise, nutrition, sleep, avoidance of disease-causing agents, practicing preventive medicine, early treatment of diseases and medical conditions, cognitive stimulation, avoidance of iatrogenic complications • Functional- Strength, balance, flexibility, conditioning

10. OPTIMAL AGING Components of Optimal Aging- Mind and Spirit • Social- Support, activities, work, volunteerism, sexuality, religion, spirituality, “other-orientation” • Psychological- Attitude, viewpoint, stress management, resilience • Societal- Health education, chronic disease self management training, access to information, community services, environmental design, health policies and insurance

11. Eleanor Hyndman, Age 80 Started karate at age 78. Says it gives her mental sharpness Recently won a gold medal. Is a Purple belt.

12. Our Aging Population • 13% of the population is above age 65 • Persons above age 85 are the fastest growing segment of the population • More 85 year olds are alive today than Ever Before • Florida is 1st in percentage of Older Persons • California is 1st in number of Older Persons • Michigan is 8th in the number of Older Persons • An increased percentage of Older Persons is happening all over the world • Peak is expected in 2050

13. Helen Zechmeister, 81 y/o Deadlift 245 lbs She once competed in a men’s 35-yrs and older bracket because there were no other women. She won.

14. BODYCHALLENGES Biological • Impaired taste or smell • Impaired vision • Multiple medications • Cognitive deficits • Difficulty swallowing • Stomach/intestine diseases • End-stage disease

15. BODYCHALLENGES Functional • Manual dexterity problems • Mobility limitations • Falls • Incontinence

16. Preserving The BODY Promotion of Optimal Nutrition • Replace saturated and trans-fats with unsaturated fats • Substitute whole-grain carbohydrates for refined-grain carbohydrates • Substitute nuts, beans, chicken, and fish for red meat • Eat 9 servings per day of fruits and vegetables • Use alcohol in moderation • Take a daily multivitamin.

17. Preserving The BODY • Poor nutrition and weight loss is associated with excess mortality, frailty, and a loss of quality of life. • Nutritional interventions play a major role in disease management and have been shown to limit the progression of disease. • Dietary interventions may decrease the risk or progression of macular degeneration, stroke, heart attacks, and lipid abnormalities, osteoarthritis , osteoporosis, and some cancers

18. Preserving The BODY • Exercise is the single most important health-promoting activity a person can engage in • Maintaining a healthy body weight has also been shown to promote optimal aging • Sleep appears to be important in optimal aging • Lack of sleep may be related to hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. • result of this hyperactivity is excess glucocorticoid production, and glucocorticoids are toxic to the hippocampus

19. Preserving The BODY • Alcohol is often considered unhealthy • but appears to have a positive effect on health, with moderate consumption • Tobacco is the single most important disease-causing substance to avoid • it appears that stopping smoking, even after age 70, is associated with improved health. • Recommendations regarding the use of prophylactic aspirin are also controversial • consider the risk and benefits in deciding whether to take aspirin for cardiovascular prophylaxis.

20. Preserving The BODY • Avoiding or Reducing Stress • reduction techniques such as regular exercise, breathing exercises, tai chi, yoga, and meditation can all play a role in the reduction of chronic stress if it cannot be avoided. • Avoiding or Reducing Depression • Depression is known as a risk factor for the development of dementia and is associated with chronic elevations of serum cortisol. • Exercise can improve depression

21. Preserving The BODY Exercising to Promote Optimal Aging • Do some form of exercise for 30 minutes a day (some is better than none) • Never use an elevator or escalator when stairs are available • Walk or bike on errands that would take less than 10 minutes to drive • Don’t use remote control devices. • Use manual devices when possible (eg, lawn mower, broom)Park a long distance from the main door when shopping.

22. Preserving The BODY Exercises to Improve Balance • Engage in exercise that requires balance (eg, tai chi, dancing) • While standing in line or cooking, stand on one leg (or with feet in tandem). • Try heel or toe walking for short distances (10-20 ft) • Stand up and sit down on chairs using one leg (with hand support if needed).

23. Preserving The BODY Exercises to Improve Strength • Lift small weights (one can of peas) in a plastic shopping bag, • 10 repetitions on each side (vary the muscle groups). • Bag handles with a can inside can be placed over feet to exercise the leg muscles. • Do sit-to-stand-to-sit exercises while watching TV. • Join a health club that has both free weights and weight machines, and do strength training 2-3 times per week.

24. MIND and SPIRITCHALLENGES Psychological/mental health • Depression • Dementia • Bereavement • Substance abuse • Pre-death concerns

25. MIND and SPIRITCHALLENGES Social • Isolation • Recent moves • Institutionalization • Fear of crime • Fear of falling • Poverty

26. MIND and SPIRITCHALLENGES Societal • Lack of resources in health education, • Increasing chronic disease • Poor self management training • Poor access to information • Lack of and limited access to community services • Environmental design geared to the able-bodied • Confusion about health policies and insurance

27. Preserving The BODY and MIND Promotion of Optimal Cognitive Health • Take a multivitamin • Engage in mentally stimulating activities • Remain socially engaged • Exercise regularly (Body and Mind) • Develop methods to detect and reduce stress (eg, relaxation, yoga, meditation) • Avoid or Reduce Depression • Get adequate sleep

28. Preserving The MIND and SPIRIT

29. Preserving The MIND and SPIRIT The POWER of POSITIVE ATTITUDE • Increased longevity (Danner et al., 2001) • Reduced morbidity (Goldman et al, 1996; Russek & Schwartz, 1997) • Increased cognitive flexibility (Ashby et al., 1999) • Improved memory (Isen et al., 1978)

30. Preserving The MIND and SPIRIT The POWER of POSITIVE ATTITUDE • Improved decision making (Carnevale & Isen, 1986) • Increased creativity and innovative problem solving (Isen et al., 1987) • Improved job performance & achievement (Wright & Staw, 1994; Staw et al.,1994) • Improved clinical problem solving (Estrada et al.,1997)

31. Preserving The SPIRIT • Self-Esteem • Having something to offer to others • Personal goals for the future • Belief in something larger than self • Ability to adapt to new and changing circumstances • Belief that you are important to others or the world • Seeking happiness and joy for one’s self and others • Desire to live one’s life to the fullest • Making peace with one’s life and death

32. Ada Thomas Age 72 Started jogging at age 65 First marathon at age 68. “When I look in the mirror… I like what I see”

33. OPTIMAL AGING References Brummel-Smith K, Optimal Aging, Part 1: Demographics and Definitions, Annals of Long-Term Care, vol. 15,issue 11, November 2007 Brummel-Smith K, Optimal Aging, Part 2: Evidence-Based Practical Steps to Achieve It, Annals of Long-Term Care, vol. 15, issue 12, December, 2007