Women and Healthy Aging Dean Sherzai MD, MAS, PhD (c)

1. Women and Healthy Aging Dean Sherzai MD, MAS, PhD(c) Director of Loma Linda Memory and Aging Center Director of Loma Linda University Neurology Research Program

2. Population Pyramids20002050 Toshiko Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingand Health.aspx, Source: World Population Prospects: The 2004 Revision (2005).

3. Demographics • The number of older adults is expected to double within the next 25 years • By 2030 about 1 in 5 Americans (72 million people) will be >65 • The age group >85 is now the fastest growing age population • 1/3 of older people live alone; 2/3 live with or near family

4. Demographics • Few live in skilled nursing facilities (15% of those >85) • 70% of total net worth in U.S. • 85+ population with Alzheimer’s Disease is close to 50% and is growing • Aging (Baby) Boomers have been turning 65 this year

5. CENTENARIANS 1900 – RARE 1982 – 32,000 1998 – 61,000 2050 – 600,000

6. SUPER-CENTENARIANS

7. Active Aging Picasso > 90 T. Vecellio (Titian) > 90 Michelangelo sculpted at 89 Verdi wrote “Falstaff” at 84 Galileo > 75 Linus Pauling > 80 Martha Grahamdanced till 75 and choreographed at 95 Artur Rubinstein’s last recital at 93 and many other....

8. Gladys "Glady" Burrill, 92

9. Overview • Aging and Health • Chronic Disease in Later Life • Health Promotion • Lifestyle changes • Screening and prevention 9

10. Causes of Death for People >65 National Vital Statistics Report, 2002: • Heart Disease – 32.4% • Cancer – 21.7% • Stroke – 8.0% • Chronic lower respiratory disease – 5.9% • Influenza and pneumonia – 3.1% • Diabetes – 3.0% • Alzheimer’s disease – 3.0% • Other – 22.08%

11. Chronic Diseases • The most prevalent chronic conditions in people >75 are much more common in women • Racial and ethnic differences in health status continue with the leading causes of death and disability dramatically higher among racial and ethnically diverse populations

12. Key Strategies for Improving the Health of Older Women • Healthy Lifestyle Behavior • Injury prevention • Clinical preventive services • Immunization and preventive screenings • Management techniques for those with chronic illnesses Adapted from Generations (2005)

13. Self-Efficacy • Self-efficacy implies control and places one’s wellness in one’s own hands • Often older people place the responsibility for their health in the hands of physicians and nurses • We need to change older people’s expectations of physicians, particularly in the area of health prevention and health maintenance

14. Aging and Health

15. The Aging Process • Generally involves slowing down of systems • Varies greatly among individuals • Influenced by genetics, environment, lifestyle factors

16. Physical Changes of Aging • Pumping effectiveness decreases • Muscle mass decreases • Some loss of cell structure and function • Dryness, slower healing • Less efficient • Decreases in depth perception, color perception, and peripheral vision • Decreased acuity, esp. higher pitch • Mineral loss faster than replacement • Decreased taste buds, salivaproduction Heart Muscles Brain Skin Kidney Vision Hearing Bones Taste

17. Chronic Disease in Later Life

18. Definition Chronic disease: • Prolonged health condition • Can last for many years • Rarely cured completely • Care is aimed at managing symptoms, preserving function, and minimizing further damage

19. Examples • Diabetes • Heart Disease • Arthritis • High blood pressure • Cancer • Low Vision • Depression • Kidney Disease • Dementia

20. Why is it Important? • Chronic diseases are the most prevalent and disabling conditions facing the elderly • Four of every five elders have at least one chronic disease • Chronic disease can dramatically reduce quality of life • Chronic diseases account for over 75% of U.S. medical care costs (CDC, 2005)

21. Consequences/Impact • Loss of function • Loss of mobility • Loss of independence • Disability • Pain • Death

22. Risk Profiles Combination of Causes • Aging • Lifestyle • Environment • Heredity • Stress • Unknown

23. Health Promotion

24. Definition • Increasing awareness of health issues • Promoting healthier behaviors • Creating supportive environments • Developing preventive strategies • Encouraging early detection and treatment (Am J Health Promot. 1989;3:3–5)

25. Why is it important? Improve quantity and quality of life • Reduce risk of developing chronic conditions • Reduce the damage or limitations that result from an already existing chronic condition • It’s never too early and it’s never too late to start healthy habits

26. What can we do to promote health? • Stop smoking • Get active • Eat a healthy diet • See a doctor regularly • Get immunized • Get screened

27. See Your Doctor Regularly

28. See Your Doctor Regularly • Early detection usually means a better outcome and less invasive treatment • Regular check-ups should include dental, vision and hearing checks • Get recommended screening tests done • Get recommended immunizations

29. General Screening Recommendations*check with your doctor for specific recommendations • Pap test – every1-3 years up to age 65 • Lipid Screen – every5 years, starting mid-thirties (male) or mid-forties (female) up to age 70 • Mammogram – every 1-2 years, age 40-74, then optional • Fecal Occult Blood – every year, age 50-80+ • Lower GI Endoscopy – depending on individual factors, every 5-10 years, starting at age 50 • PSA – optionally, every year up to age 70 (men) • Bone density – mid-sixties

30. Immunization Recommendationsfor older adults • Influenza – every year age 65-80 (optional age 50-64) • Pneumonia – once at age 65 • Td/Tdap – every 10 years • Zoster (Shingles) – once at age 60

31. Health Promotion • What unhealthy habits are common in your community? • Is there an increasing awareness of healthy lifestyle changes? • What barriers to better health habits exist in your community? • What are some nutritional issues affecting older people in your community? • What resources are available in your community to help seniors get adequate nutrition?

32. The best thing to do to feel better is to get regular exercise

33. Get Active • Lack of activity and poor diet are second only to smoking in contributing to cause of premature death • A sedentary lifestyle contributes to many chronic diseases including: Heart disease, Cancer, Hypertension, Obesity, Lipid Abnormalities, Diabetes, Depression, Osteoporosis

34. Benefits of Physical Activity • Increased energy • Increased muscle strength and flexibility • Better insulin response • Improved mood • Increased cardiovascular fitness • Increased bone mass • Better immune function • Increased independence • (National Institute on Aging, 2004)

35. What Can I Do to Be More Active? • Work toward 30 minutes of aerobic activity most days of the week • Do things that use your muscles • Do things that make you use your balance • Stretch to maintain flexibility • Do things you enjoy or try something new:walk, bike, garden, yoga, tai chi, dance • Mix it up! Always talk to your doctor before starting an exercise program

36. Eat a Healthy Diet

37. Why is it Important? • It has been estimated that 10 to 25 percent of elderly people suffer from poor nutrition • Poor nutrition can contribute to:

38. Quick Tips for Healthier Eating • Eat more fruits and vegetables • Eat whole grains, nuts, beans • Choose foods low in saturated fat, trans fat, and cholesterol • Get enough calcium • Get enough protein from low fat sources • Cook with less fat • Minimize foods high in sugar • Drink enough water

40. Calcium As women get older their bones lose calcium and get weaker and more breakable Its very important for women to eat lots of calcium-rich food like milk, yogurt, broccoli, oranges and leafy greens Heartland Alliance Refugee Health Programs

41. The Aging Brain

42. The Aging Brain No Change Change • Loss of volume • Memory retrieval • Processing speed • Multi-tasking • Memory formation efficiency • Verbal IQ • Vocabulary • Store of information • Comprehension

43. Brain Changes With Aging • Brain weight: • Decreases by about 0.5% per year after age 30! • Neuron loss: • Region-specific • 10-25% loss in cerebellum, cortex, hippocampus, substantia nigra, Frontal Lobe • Loss of synapses (connections between neurons) • Mild degree of Alzheimer-type pathology

44. Causes of Memory Changes in Aging • Normal aging * • Neurodegenerative diseases / Alzheimer’s disease • Medications • Alcohol • Depression • Anxiety • Head trauma

45. Alzheimer’s disease Normal Aging Mild Cognitive Impairment No change over time Other dementias

46. Mild Cognitive Impairment • Variable definition • Originally defined as a memory only syndrome • Defined loosely -include memory and cognitive problems, yet normal ability to do ADLs • Conversion to AD at a rate of about 10-15%/year • Normal elderly – 1-2% per year • The non- memory types are those at risk for other types of dementia

47. What is Dementia? Loss of memory and other intellectual abilities serious enough to interfere with daily life Alzheimer’s is most common form of dementia, but there are many other reasons........

48. Degenerative Diseases • Alzheimer’s disease (>60%) • Lewy Body Disease (20%) • FTLD (2-5%) • Parkinson’s disease and Dementia (PDD) • Huntington’s • PSP • Some others: CBGD, Kearns-Sayre, Hallervorden-Spatz, Wilson’s disease, etc.

49. What is AD? • AD Statistics…. • Most common cause of dementia among people age 65 and older. • 5.3 million people now have AD. • 1 out of 8 over 65; 1 out of 2 over 85 • For every 5-year age group beyond 65, the percentage of people with AD doubles. • By 2050, 13.2 million older Americans are expected to have AD if the current numbers hold and no preventive treatments become available.

50. Brain Mass Change