Here are key takeaways from a KET Forum examining best practices to ensure optimal health as we age. Host Dr. Wayne Tuckson and guests discuss recommended lifestyle habits, helpful exercises, establishing a productive patient-physician relationship, advice for medications and medical procedures, and other topics.
1) As the years advance, it’s vitally important to adopt healthy lifestyle habits such as a nutritious diet, regular exercise, arranging a safe living space, and scheduling routine check-ups with a primary care practitioner.
“I think getting ahead of any chronic diseases is extremely important in having that quality of life and that longevity that we really want,” says Dr. Misha Rhodes.
Rhodes is the chief medical officer for the nonprofit CenterWell system, which serves Louisville-area seniors and uses a holistic approach to patient care. She says every person will have different goals for their later years, but good health is crucial for all of them. To that end, she recommends that folks develop an individualized health care plan with their primary care physician, combining appropriate exercise, diet, and disease management.
“You’re having someone helping and partnering with you in your health care, because the goal is to have the best quality of life as possible,” Rhodes says.
Of course, one of the best ways to achieve a high quality of life is through regular exercise. Bryant Stamford, professor of kinesiology and integrative physiology at Hanover College, puts it succinctly: “The closest thing we have to an elixir, a fountain of youth, is exercise.”
It is essential, Stamford says, to routinely test muscle groups and the cardiovascular system in order to maintain strength and fitness. According to the U.S. Centers for Disease Control, the benefits of regular exercise for seniors include improved balance and bone strength as well as a reduced risk of dementia, stroke, and heart disease.
Stamford lists three basic exercises that will help people reach most of their goals: walking, climbing stairs, and carrying things. For all three activities, he recommends to start slowly, set achievable goals, and gradually increasing them as fitness improves.
“When something becomes challenging, that should be a heads-up call to you to do more of it, not less of it,” Stamford says.
Rhodes agrees with this “use it or lose it” guideline, and adds that it’s important to make sure any exercise routine is safe and geared toward each individual’s abilities. To that end, she and her staff at CenterWell may incorporate physical therapy to assist patients as they start on an exercise program, and spot-check their homes for any issues that might cause problems during activity, such as clutter or a lack of guardrails on stairs.
Roy Tapp of the Kentucky Safe Home Coalition recommends several steps for patients who may have started new medications that affect their equilibrium or are otherwise losing some mobility. He advises them to clear all walkways in their homes of any items that pose tripping hazards, such as electrical cords and pet or children’s toys. He also suggests adding hand holders and suction strips to bathtubs and showers. Outside of the house, he advises clearing any debris off of walkways or paths, and he urges people to avoid wearing flip-flops for anything other than casual walking.
“One tip I would give is to have a family member or a neighbor to come by and do a self-check,” he adds. “Look around and see what one may have missed.”
Two aspects of optimum health that should not be overlooked are following a healthy diet and getting enough sleep. Rhodes notes that appetite decreases with age and he stresses the importance of getting enough nutrition, even if it requires eating smaller portions more often throughout the day.
“Maintaining sleep hygiene is important,” says Dr. Zain Guduru, a neurologist at the University of Kentucky Neuroscience Institute who specializes in movement disorders. Elderly persons might not require as many hours of sleep every night and might nap more frequently during the day, but keeping a regular schedule and removing distractions from one’s bedroom is crucial. “If (sleep hygiene) is not helping, there are a variety of medications – including something available over the counter, a natural substance called melatonin – that can sometimes help,” Guduru says.
2) Learn the warning signs of physical and cognitive ailments, and be proactive in contacting your medical providers if they arise.
“As we get older, the typical run-of-the-mill illnesses may present differently,” Rhodes says. An example is urinary tract infections (UTIs), which occur mainly among women in the younger age cohort but more often among males in the older one. Rhodes says elderly persons who develop a UTI will exhibit traits such as confusion or delirium and extreme fatigue, and therefore require a more comprehensive medical treatment once they are diagnosed.
It is normal to lose some connections, or synapses, between neurons in the brain as we age, says Guduru. But it’s important to understand the warning signs of more serious, long-term cognitive ailments such as tremors, having a stroke, Parkinson’s Disease, and Alzheimer’s Disease.
One of the most important early signs is losing one’s balance. If incidents arise involving unsteady gait, tripping, or nearly falling, Guduru says a primary care physician should be consulted.
The neurologist explains that tremors – especially occurring at rest – and balance or movement problems are common early symptoms of Parkinson’s Disease, which is second only to Alzheimer’s Disease as the most common cognitive disorder among those over age 65 and affects roughly 1 million Americans. Other symptoms of Parkinson’s include stiff muscles that can result in a blank facial expression, and mumbling speech.
“If you come and tell (your physician) about any balance problem, we will evaluate and see what needs to be done,” he says. “What is the reason behind it, and what needs to done right at that time. It might be about education, and it might be about management of that particular problem.”
Once a diagnosis is made for a neurological condition that affects movement, Guduru advises patients to follow all instructions from the physician and/or physical therapist. “It’s about teaching what to do and what not to do, and also teaching about what kind of exercises should be done on a regular fashion,” he explains. “Once your physical therapy ends, do not stop there. Those regular exercises need to continue.”
Alzheimer’s Disease is the most common form of dementia, and the progressive condition resulting in memory, thinking, and language loss affects nearly 7 million Americans age 65 and older. Guduru says that Alzheimer’s can manifest in early stages with a loss of short-term memory and/or word recall that occurs regularly. He adds that often, a patient’s family member or friend will be the first person to notify him about these changes.
“If you also happen to see any sudden change in the (patient’s) personality too, that’s a red flag to go to the doctor,” he adds.
3) Keep up with all preventative screenings recommended by your physician and by health officials.
Over the past decades, breakthroughs by researchers have helped drive down incidence rates for many chronic maladies, from certain cancers to coronary artery disease. This has occurred due to improved treatment, but also in many cases due to the development of early screening tests. Every year, protocols for early disease screening based on medical evidence are set and adjusted by the United States Preventative Task Force.
“Part of what (it) does is look long and hard at the evidence for the benefit or the harm for a screening test that could prevent disease or detect it at an earlier stage, or make recommendations to help people in this nation live longer, healthier lives,” says Dr. John Wong, vice chairman of the Task Force.
As an example, he says the Task Force has lowered the recommended age for starting to get screened for colorectal cancer down to 45. This is based, he explains, on new data revealing a 15 percent increase in colorectal cancer diagnoses among persons under the age of 50.
“Science changes,” Wong says. “Our tests change, our treatments change, and as you can see, the development of diseases, because of population-based behaviors or other factors in the country, increase.” By adjusting the screening start-off point for colorectal cancer, Wong hopes the recent increase in incidence rates will eventually reverse.
On the other end of the age spectrum, protocols for screenings of certain diseases might expire. While preventive screenings for colorectal cancer are recommended until age 75 for the entire population, Wong says a decision about screening from age 76 to 85 should be made by the patient and physician, and based on the patient’s health profile.
“When a patient is older, there’s a closer balance between benefits and harms (for screening),” Wong says, “That may depend on a patient’s situation, it may depend on a patient’s other diseases that they may have, and whether or not, for example, they’re a candidate to possibly have surgery.”
Wong adds that for some diseases, such as breast cancer and mammograms, the Task Force does not have enough scientific data to determine an end point for getting screened. In this and similar cases, he again stresses the importance of patients and providers openly communicating about the best way forward.
In her experience, Rhodes says it’s usually not difficult to talk with elderly patients and their families about whether to get preventative screening. She and her staff at CenterWell make it a point to consider the patient’s overall health and quality of life goals and come to a satisfactory decision together.
“I think the most important thing is information – making sure the patient is informed, with all the upsides and downsides, (and) what does this mean,” says Rhodes. “I think a lot of times we tell everybody to get preventative screenings, but we’re not (considering) what happens if they find something. And I think that’s the conversation that has to happen.”
4) Consult with your medical team as well as family members before any surgical procedure to minimize the risks associated with older patients.
Advances in knowledge and technology have aided physicians across the board in treating elderly patients, including during surgery. Many persons over age 65 will benefit from getting hip or knee replacements and ending a cycle of chronic pain, yet there are risks associated with those procedures that increase with advanced age.
At CenterWell, Rhodes says a surgical remedy for a patient should occur only after all non-surgical methods of treating the medical issue have been exhausted. “Whether it’s physical therapy, whether it’s medicine or exercises, and then sitting down and really reviewing the patient’s medical history,” she explains. “What are your chronic illnesses? What chronic diseases could put you at risk to undergo major surgery, particularly when talking about anesthesia? We want to make sure we’ve optimized you to become the best surgical candidate you could possibly be going in.”
For elderly patients, complications from surgical anesthesia pose the greatest health risks, says Dr. Jiapeng Huang, vice chairman of the Department of Anesthesiology at UofL Health. First, he explains, the cardiovascular system does not function as well as we age, and patients under anesthesia have a higher chance of developing very low blood pressure.
“The second thing I worry about is the pulmonary system, the lungs,” Huang continues. “When we get older, the ability for us to breathe when the oxygen levels are low is decreased.” Using opioids for pain control during the procedure can elevate the risk of low pulmonary function, he adds, and patients who smoke are at an elevated risk of post-operative breathing problems.
A third risk involves post-operative cognitive dysfunction. “Simply put, some elderly patients after anesthesia and surgery have trouble with memory loss, trouble with thinking,” he notes. “This is something our community has been studying quite a bit, to see how to try to reduce that chance.”
Huang says it’s important for patients to know about these risks before deciding to undergo surgery, and the best way to do that is to meet with their anesthesiologist. “We want to talk to you, so stop by our pre-anesthesia clinic and we’ll get all of your information,” he advises. Huang also recommends bringing a family member or friend that will serve as caretaker after the surgery to the clinic.
Obviously, patients undergoing surgery who are in good physical condition for their age will have a lower risk of developing complications. Huang says the main pillars of healthy aging – getting regular exercise, following a nutritious diet, and stopping tobacco use – will support a successful surgery and recovery.
Post-surgical patients may be prescribed medication to help alleviate pain, but Rhodes says those drugs can be problematic for elderly individuals. “Because a lot of the medications we use are opioids and we know what they can do: They can sedate you, make you more sleepy, depress your breathing, there are a lot of things that can happen, and that can lead to falls. It can lead to being unaware of your surroundings, and it can also cause medication errors in your normal daily typical medication.”
Rhodes adds that the overall recommendation for pain medication when treating elderly surgery recipients is to “start low, and ramp up slow,” which is accompanied by frequent check-ups to monitor any possible side effects.
