Healthy
Aging
HEALTHY AGING Publisher Melvin Miller
Healthy Aging
Health Editor Karen Miller
Healthy aging: Living longer and living better................... 4 Typical aging vs. signs of dementia ............................ 5
Senior Editor Yawu Miller
Q&A with Dr. Jatin Dave................................................... 7
Art Director Marissa Giambrone Proofreaders Rachel Reardon Martin Desmarais For advertising opportunities Please contact Karen Miller at (617) 261-4600 x7800 or kmiller@bannerpub.com. Be Healthy is published by Banner Publications, Inc. Volume 1 • Number 4 Winter 2014
Depression in the elderly................................................. 9 Immunizations................................................................. 10 Recommended guidelines for vaccines........................ 10 Resources....................................................................... 11 Prevention guidelines....................................................... 12 STDs and the elderly ....................................................... 13 Fear of falling .................................................................. 14 Causes of falls in older adults..................................... 14 Check your risk for falling ............................................... 15
Healthy steps
Photo from front page: Purestock/Thinkstock
One foot in front of the other ........................................... 16 Fall-proof your home ................................................. 17
Be Healthy is printed by Cummings Printing 4 Peters Brook Drive P.O. Box 16495 Hooksett, NH 03106 603-625-6901
T’ai chi: Keep your life in balance .................................... 18 Challenge to healthy eating.............................................. 21 What’s for dinner?........................................................... 22 Ginger honey glazed salmon ........................................... 23
January is Glaucoma Awareness Month Glaucoma, called the “sneak thief of sight,” is common among those over 60.
behealthy.baystatebanner.com 3
HEALTHY AGING Living longer … and living better
Monera B. Wong, M.D., M.P.H.
Associate Chief, Geriatric Medicine Massachusetts General Hospital
I
t’s inevitable. If you make it through another day, you are 24 hours older, moving steadily toward senior citizenship. You are not alone. By 2030 — just 16 years away — one-fifth of the U.S. population will be 65 years or older, says the U.S. Census Bureau. This group will look very different from the elders of today; they will be fitter and more ethnically and racially diverse. Blame it on the baby boomers, the large group of post-war babies born between 1946 and 1964. Also to blame are vast improvements in public health and medical treatment that enable people to live well into their 80s and 90s. Some even top the century mark.
4 Be Healthy | Healthy Aging
Though there’s no magic pill to slow the aging process, Dr. Monera Wong, associate chief of Geriatric Medicine at Massachusetts General Hospital, makes a good point. “You can’t slow down the process of aging,” she said, “but you can age better.” There is a big difference in elders of long ago and today. “People are not only living longer, they are living well for longer,” she said. “Disability in the elderly is much less now.” In 1900 the life expectancy in Massachusetts was 45 years according to Massachusetts Deaths 2010, a publication of the Massachusetts Department of Public Health. Those born in 2010 are expected to live until the age of 81, almost double the number of years. Unfortunately, what often accompanies extended years is a hike in chronic disease. And it usually comes in pairs or more. As noted by the Centers for Disease Control and Prevention (CDC), two-thirds of older Americans have multiple chronic diseases. Cataracts may cloud the vision and the hearing doesn’t work quite as well. Gray hairs are commonplace, bones lose density and muscles their strength and flexibility. There are more troublesome changes as well. Kidneys lose efficiency in removing waste from the bloodstream. Some conditions common in African Americans, such as high blood pressure and diabetes, can damage kidneys even further. Medications can also be harmful. Incontinence, or loss of control of the bladder, is fairly common. Older men often experience an enlarged prostate, which makes emptying the bladder difficult. Postmenopausal women can experience stress incontinence as the muscles controlling the bladder weaken. Harder hit is the cardiovascular system — the heart and connecting blood vessels. An older heart becomes a less efficient pump, and
the arteries, which carry oxygen-rich blood from the heart to the muscles and organs, become narrow and inelastic, leading to high blood pressure. According to the National Heart, Lung, and Blood Institute, there is a 90 percent chance of developing high blood pressure after the age of 55. High blood pressure can lead to stroke, heart failure, heart attack and kidney failure — all common in the elderly and blacks as well. Of principal concern are the brain and nervous system. Memory gets a bit fuzzier; reflexes a little slower. A major fear is Alzheimer’s disease, a chronic, debilitating condition that robs the elderly of not only their memory, but the ability to reason and understand. The picture may look bleak, but actually, many elders are faring quite well. The State of Aging and Health in America 2013, published by the CDC, has developed report cards on health indicators in four areas: health status, health behavior, preventive care and screening and injuries. The scores range from one to four, one being the best. The less favorable scores for the Commonwealth were for vegetable consumption, obesity and injuries. Only 29 percent of
elders said they ate veggies three or more times a day in comparison to 40 percent in Tennessee. Almost 23 percent are obese and more than one-third sustained an injury from a fall within the past year. In Hawaii, 16 percent of senior citizens are tipping the scale and less than one-fourth of older citizens sustained injuries from a fall in Wisconsin. On the other hand, Massachusetts was one of the leading states in oral health, fruit consumption, disability days and vaccines and screenings. Most of the elderly in the state had retained most of their teeth, a key factor in good nutrition. Only onethird indicated that they were limited in any way because of physical, mental or emotional problems. Massachusetts had some of the highest rates for flu and pneumonia vaccines and colorectal screening. It surpassed all states in the percent of women 65 and older who had received mammograms within the past two years. Almost 90 percent had been screened for breast cancer, considerably higher than 72 percent of the women in Alaska.
“ People are not only
living longer, they are living well for longer.
”
— Dr. Monera Wong
Healthy Aging, continued to page 6
TYPICAL AGING VS. SIGNS OF DEMENTIA Missing a monthly payment
Inability to manage a budget
Remembers recent important events
Noted decline in memory of recent events
Forgetting which day it is and remembering later
Losing track of the date or season
Complains of memory loss but able to provide detailed examples of forgetfulness No change in interpersonal social skills Sometimes forgetting which word to use Losing things from time to time
May complain of memory loss only when asked Loss of interest in social activities; inappropriate behavior Difficulty having a conversation Misplacing things and being unable to trace steps to find them
Making a bad decision once in a while
Poor judgment and decision making Source: Alzheimer’s Association, Helpguide.org
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HEALTHY AGING
6 Be Healthy | Healthy Aging
According to recent studies, exercise not only helps the heart, muscles and bones by increasing blood flow throughout the body, it has also been found to keep the mind sharp and improve memory. A nip now and then is fine, but health experts recommend no more than two drinks a day for men and one a day for women.
Staying mentally active and socially engaged is key. Wong bristles at the misperceptions often repeated about older adults. Memory loss is not a normal part of aging and not everyone gets dementia, she explained. And you don’t have to shout; not all senior citizens have hearing loss. Not all older people are dependent for care. Some go through their lives entirely independent of others, she said. Another common belief is that elders are not computer savvy, but a report on Internet use and the elderly by the Pew Research Center put that myth to bed. The study found that half of adults 65 and older use the Internet or e-mail. Moreover, 70 percent have cell phones. Not only are seniors surfing the web, onethird are “liking” on Facebook or “following” on twitter or some other social networking site. Eighteen percent do so almost daily. Wong said she marvels at the resilience of her elderly patients. “I’m amazed at the tragedies they have survived and how whole they remain,” she said. “I don’t know if I could do it.”
Jupiterimages/Stockbyte/Thinkstock photo
The good news is that poor health is not an inevitable consequence of aging. Wong explained that often seniors do well physically, until they hit 75 or 80 when an accumulation of medical conditions surface. Yet, it is possible to delay or prevent many illnesses. A healthy lifestyle can keep many of the changes at bay. Even better news is that it’s never too late to adopt the triad for healthy living — smoking cessation, healthy eating and weight control and exercise. “Not smoking is extremely important,” she said. “And if you do smoke, it’s never too late to quit.” The risk of heart disease drops significantly after smokers break the habit. Eating a variety of fruits, vegetables and whole grains can improve nutrition. Choosing foods low in trans and saturated fats, sugar and salt can minimize the dangers of cardiovascular disease and obesity. All adults regardless of age are recommended to get at least 150 minutes a week of moderate-intensity exercise, such as brisk walking and muscle strengthening activities, such as t’ai chi, on two or more days a week.
Fuse/Thinkstock photo
continued from page 5
Q& A WITH DR. JATIN DAVE Why does bone density decrease with age? Can it be prevented?
Our bone is constantly undergoing remodeling; old bone is removed and new bone is added. These two processes — bone resorption (removal) and bone formation change with aging. After age 35 or so, bone resorption outpaces formation and therefore bone density, or bone strength, begins to decline. Bone loss can be prevented by not smoking, engaging in regular physical activity, eating a diet rich in calcium, and eating foods fortified with vitamin D or taking vitamin D supplements. In addition, bone density can be tested by x-ray to check for osteoporosis or weak bones. Osteoporosis can be treated with medications to improve bone strength. Jatin Dave, M.D., M.P.H.
Geriatrician, Brigham and Women’s Hospital Medical Director, Geriatrics Tufts Health Plan
Is an elderly person too old to start an exercise program?
It is never too late to be more physically active and to start an exercise program. Age-related disability is preventable with regular physical activity at any age, including adults in their 80s and 90s. “I am too old to benefit from exercise or physical activity” is a common myth that causes many older adults to stop exercising or not start. Staying active and exercising regularly has both physical and emotional health benefits even in the very old. Being physically active (performing every day activities such as house work, walking and gardening) is just as important as formal exercise programs. Exercise can help prevent or delay many diseases and is effective in treating many chronic conditions.
Why does balance deteriorate with age?
It is unclear whether balance deteriorates universally with aging or frequent falls are caused by an increase in age-related disorders. Good balance requires sensory input (from eyes, inner ear and feet), muscle strength and joint mobility. Therefore, vision problems, such as cataracts or glaucoma, inner ear disorders, or weak muscles and stiff joints due to sedentary lifestyle can lead to balance problems and associated falls.
Is there a point at which the elderly should discontinue screening tests?
Evidence to support routine screening tests after age 75 years is limited. I recommend screening tests based on the functional status of the person and not solely on age. Estimated life expectancy and expected time to benefit from the test are other factors to consider. For example, selective screening tests could be appropriate for an 80-year-old woman who is active and highly functional while the same screening tests are not indicated for a 75-year-old man who has advanced dementia and is now bedbound.
Do older adults require less sleep than younger adults?
As people age they tend to have difficulty falling asleep and more trouble staying asleep. It is a myth that older adults need less sleep than younger adults. In fact, research shows that our sleep needs remain constant throughout adulthood. What changes are sleep patterns, which can lead to sleep problems.
Is it possible for older adults to change unhealthy habits, such as smoking?
Yes. It is never too late to change many of these unhealthy habits, such as smoking. Many benefits of smoking cessation (including reduced risk of cardiovascular problems) can be seen within a few months of quitting.
Is memory loss inevitable as a person ages?
Memory loss is not inevitable with aging, but some loss of episodic memory, such as recollection of specific episodes, is common. Loss of semantic memory, which refers to understanding of concepts or general knowledge, is not a normal part of aging. Progressive and persistent loss of memory with impact on function is common with dementia. Learning new skills or languages can help preserve memory.
Is high blood pressure unavoidable since its incidence increases with age?
After age 40, on average systolic blood pressure (the upper number) increases by 7 mm Hg each decade, reaching an average of approximately 140 mm Hg by the eighth decade. Diastolic pressure (the bottom number) also increases with age but at a lower rate than systolic pressure. Diastolic pressure may even fall at late ages. By age 70, over three-fourths of U.S. adults have hypertension. Regular physical activity can help prevent hypertension.
Why does obesity increase at age 60?
With aging, one begins to lose muscle and add fat often leading to obesity. Weight gain occurs during middle age, frequently due to sedentary lifestyle and high caloric intake. Regrettably, many older adults associate weight gain and a sedentary lifestyle with aging. Since daily recommended calorie intakes generally decrease with age, it is important for older adults to choose foods wisely to meet their nutritional needs and stay physically active. behealthy.baystatebanner.com 7
8 Be Healthy | Healthy Aging
Fuse/Thinkstock photo
DEPRESSION IN THE
ELDERLY
When fun things are no longer fun
There are many changes to expect as one enters the senior years, but depression is not one of them. “Depression is not a normal part of aging,” explained Dr. Olivia I. Okereke, the academic director of the Geriatric Psychiatry Program at Brigham and Olivia I. Okereke Academic Director Women’s Hospital. Geriatric Psychiatry Program It’s not expected, but it Brigham and Women’s Hospital is common. According to the Centers for Medicare and Medicaid Services, roughly 17 percent of people 65 and older have suffered from some form of depression. In response, Medicare has added yearly screening for depression to the list of tests offered at no cost to patients. Depression is common for everyone, not just the elderly, and varies by gender. Over the life span it is more common in women. “That’s a world-wide finding,” said Okereke. Although depression occurs at any age, there is one difference in older adults. “Even milder forms of depression can have an impact on the health of the elderly,” she said. “They can have worse medical outcomes.” For instance, older people may require more healthcare resources or they may not recover as well from illnesses or other medical setbacks. By all accounts depression is a complex disorder. It is hard to pinpoint its exact source and it can present in different ways. “We don’t know the precise physiological cause,” Okereke added. “However, we do know some of the risk factors that may increase its incidence in older adults.” Physical impairments that limit mobility are a major risk factor as well as serious medical events, such as stroke. There is ongoing research to see if non-medical behaviors and lifestyle choices reduce the risk of depression, said Okereke. Preliminary results suggest that people who exercise may have a lower incidence of depression. “I’m not talking about a major exercise program,” she explained. “A nice brisk walk will do.” Diet
is another factor. “We know that omega-3 fatty acids appear to be protective of mood,” she explained, referring to her research findings. Omega-3 fatty acids are found in walnuts, salmon, sardines and seafood. Okereke is also conducting research to determine whether levels of vitamin D have an effect on depression. If so, these findings could have an impact on African Americans who typically have lower blood levels of the vitamin, particularly those living in the North where sunlight is reduced. The sun is the chief source of vitamin D. The treatments available for depression are the same for everyone. However, according to Okereke, older people appear to do better with talking with their therapists, as well as taking medications, rather than medications alone. An issue for all, regardless of age, is that a substantial number of people do not initially respond to medication. It requires work to get the right medicine and dosage. Some people get discouraged if they don’t get better on the first try. Sometimes it is necessary to try a second or third time or more, she explained. The symptoms of depression in the elderly, however, can differ a bit from those in younger people. There are two core features of depression. To be diagnosed a person has to have at least one. The first is depressed mood. People are questioned if they sometimes feel sad. The second is anhedonia, or the inability to feel pleasure. People are asked if they still enjoy the things they previously enjoyed. It has been found that when older people are depressed they experience more symptoms of anhedonia than depressed mood, according to Okereke. This subtle difference may partly explain why older adults are less often diagnosed with depression. Probing questions may focus more on feelings of sadness rather than loss of pleasure. Availability of treatment for depression is critical, and is getting national recognition by Medicare and Medicaid. For instance, the Massachusetts Behavioral Health Partnership is a community-based network that integrates mental health and primary care for MassHealth members. Such integration of care is key, said Okereke. “Diagnosis of depression is important, but a more important issue is access to care and good coordination of care.” behealthy.baystatebanner.com 9
IMMUNIZATIONS A lifetime of shots
10 Be Healthy | Healthy Aging
RECOMMENDED
GUIDELINES
FOR VACCINES PNEUMOCOCCUS for Pneumonia
One dose at age 65 and older
SEASONAL FLU for Influenza Yearly
ZOSTER
for Shingles
One dose at age 60 and older
Tdap
for Tetanus/diphtheria/ pertussis One dose
Td
for Tetanus/ diphtheria
Every 10 years Source: Advisory Committee on Immunization Practices
erate this virus. Instead, it damps down its impact, but the virus remains dormant in certain nerves in the body’s nervous system. Shingles can occur if the virus becomes active again in these nerves years later. The reason
Denis Pepin/iStock/Thinkstock photo
Baby boomers might think that the days of vaccinations are way behind them. Not so fast. Adults mistakenly assume that they are permanently protected against an array of illnesses. For the most part, that is true. Many have endured the discomfort and inconvenience of several infectious diseases, while others — typically born in the 1970s or later — have been inoculated against these invaders. Protection from these diseases, whether natural or provided through a needle, is not necessarily permanent. The immune system begins to wane with age, thus diminishing the ability to fend off infectious organisms. The elderly — those 65 and above — are of great concern. They have a higher incidence of many chronic diseases, such as heart and kidney disease, diabetes and several cancers, which make them more vulnerable to certain infections and their complications. There are four vaccinations people 60 and older must have, say medical experts. The first is a yearly flu shot. People tend to dismiss the flu as just a more serious common cold that will go away with rest and plenty of fluids. In most cases, this is true, but in too many cases it is not. Influenza and pneumonia are the ninth leading cause of death for all ages in this country. The elderly are among the hardest hit. Pneumonia is the seventh largest killer of older adults, especially during the winter months. Seniors with chronic diseases are even greater targets. That’s why the second vaccine recommended for those 65 and older is to protect against the most common type of pneumonia (pneumococcal). Unlike flu shots, only one inoculation is required. The third vaccine recommended for seniors is the herpes zoster vaccine (Zostavax) that was approved by the Food and Drug Administration (FDA) in 2007. The shot is recommended only for seniors who have had chickenpox. Herpes zoster, better known as shingles, is a painful, blistering skin rash due to the virus that causes chickenpox. The immune system cannot completely oblit-
RESOURCES HEALTH & WELLNESS PROGRAMS for this sudden resurgence is not clear. Often only one attack occurs, but that’s more than enough for most people. The pain can be quite excruciating and last for several weeks. This inoculation cannot prevent chickenpox. Nor can it treat shingles, but it can significantly reduce the recurrence of an outbreak. The Centers for Disease Control and Prevention recommend the shot for those 60 and older although the FDA in March 2011 approved it for people as young as 50. The shingles vaccine protects not only the recipient, but others as well. If an adult or child has direct contact with the shingles rash on an afflicted person and has not had chickenpox as a child or a chickenpox vaccine, that person can develop chickenpox, not shingles. Barbara Walters found that out the hard way. The 84-year-old broadcaster apparently never had chickenpox as a child and developed the disease from close contact with a person who had shingles. Those with active cases should avoid physical contact with anyone who has a weak immune system, newborns and pregnant women. Only one inoculation of Zoster is recommended at this time — even for those who have suffered a bout of shingles. One other vaccine is recommended for senior. All adults, especially those 65 years and older, should get one dose of Tdap, a booster for tetanus, diphtheria and accelular pertussis (whooping cough). It has been found that the protection against these illnesses wanes with time. A Td booster to guard against tetanus and diphtheria is then recommended every 10 years. In addition, people with chronic conditions or those who engage in risky sexual behavior may require additional shots. For instance, people who have multiple sex partners or men who have sex with men are urged to be vaccinated against hepatitis B, a sexually transmitted virus that can result in liver damage. Though baby boomers might think that the days of vaccinations are way behind them, it’s clear that is not the case.
The Good Life
Action for Boston Community Development (ABCD) 178 Tremont St., Boston MA 02111 617-348-6000 www.bostonabcd.org
Fit-4-Life
Kit Clark Senior Services Inc. 1500 Dorchester Ave., Dorchester, MA 02122 617-825-5000
The Brown Bag Program
The Greater Boston Food Bank 70 South Bay Ave., Boston, MA 02118 617-427-5200 www.gbfb.org
VOLUNTEERING AND BACK-TO-WORK PROGRAMS Read to Succeed
Generations Incorporated 25 Kingston St., 4th Floor, Boston, MA 02111 617-423-6633 www.generationsinc.org
Jumpstart
308 Congress Street, 6th Floor, Boston, MA 02210 617-542-5867 www.jstart.org/where/northeast
ABLE Volunteers
Operation A.B.L.E. of Greater Boston 174 Portland St., Boston, MA 02114 617-542-4180 www.operationable.net
For more information contact Kayla Romanelli, program coordinator Tufts Health Plan Foundation at 617-972-9493.
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PREVENTION GUIDELINES The incidence of chronic diseases, such as cancer, heart disease and diabetes increases with age. Several screening tests are available to detect many of these conditions, which can lead to early medical intervention. Due to the Affordable Care Act and changes in Medicare, certain screenings are offered at no cost to patients. The guidelines below for people 60 and older are suggestions only. Those already diagnosed with a particular illness may require more frequent monitoring. Also, most of the screenings are initiated at an earlier age. Your provider can establish protocol personalized to your risk and health status.
CARDIOVASCULAR
M
F
Screening
Frequency
Blood pressure*
Yearly
Cholesterol*
Every three to five years
Diabetes (glucose)*
Every one to three years
Abdominal aortic aneurysm
Once for men at age 65 who have ever smoked
Cervical (pap smear)
Every three years until age 65; discontinue if regular screenings produced normal results
Breast (mammogram)1
Every one to two years
Prostate (PSA)
Yearly
Colorectal
Every year – fecal occult blood test Every five years – sigmoidoscopy and fecal occult fecal test Every 10 years – colonoscopy
Skin
Yearly
Head and neck
Yearly
Depression
At routine exam
Alcohol and tobacco use
At routine exam
OTHER
MENTAL HEALTH
CANCER
Yearly Obesity (BMI) As needed; initial exam for females at 65, Osteoporosis males at 70 *Those with a blood pressure exceeding 120/80 or those with diabetes, heart disease or kidney problems may require more frequent monitoring. Vision Every two years; check for glaucoma 1 Women with a history of breast cancer in the family may require additional tests and more frequent testing. Yearly Dental At routine exam Risk of falls At routine exam Medications review * Those with a blood pressure exceeding 120/80 or those with diabetes, heart disease or kidney problems may require more frequent monitoring. 1
Women with a history of breast cancer in the family may require additional tests and more frequent testing.
Source: MedlinePlus 12 Be Healthy | Healthy Aging
STDS AND THE ELDERLY
you’re never too old
HIGH RISK BEHAVIOR
Inconsistent use of condoms
New or multiple sex partners
Monkey Business Images/Monkey Business/Thinkstock photo
Chances are that if you ask a 60-year-old woman if she has been tested for chlamydia, her response will be either shock or laughter. After all, sexually transmitted diseases, or STDs, are for kids. But that’s not true anymore. That’s a hard lesson older adults are now learning. It could be because people are living longer or maybe it’s the baby boomers who are trying to keep the sexual revolution alive. In all probability, the biggest culprit is ignorance. Regardless of the reason, older adults — even those well into their 70s and 80s — are engaging in sex. And, according to a survey by AARP, a non-profit organization for people 50 and older, it’s not just once in a blue moon, particularly for older singles. Chlamydia, once considered the bane of females 25 and younger, is increasing in people 55 and older, according to a recent surveillance report by the Centers for Disease Control and Prevention (CDC). Between 2006 and 2010, the number of reported cases in that age group escalated 36 percent. More shocking is the hike in older adults in infections of HIV, the virus that causes AIDS. The CDC’s most recent HIV Surveillance Report noted that at the time of diagnosis of HIV infection, over 40% of the cases had already advanced to the AIDS stage. Undoubtedly, that “little blue pill” is causing its share of problems. Dr. Anupam B. Jena, an internist at Massachusetts General Hospital, examined the rates of STDs in men who use erectile dysfunction (ED) drugs and those who don’t. Jena and his fellow researchers found that all STDs — particularly HIV and chlamydia — are higher in users versus nonusers of ED drugs. The study also found that the rate of STDs was higher in users both before and after the prescription. In an interview, Jena cautioned that “anyone who does not practice safe sex, no matter their age, can contract an STD.” And that’s part of the problem. Older adults associate condoms with protection against pregnancy and that STDs are the purview of the young and inexperienced. But a national divorce rate hovering around 40 percent propels newly designated — and ill prepared — singles into the dating scene. In its study on sex, Indiana University determined that the percentage of condom users drops with age and that only 10 percent of women between the age of 45 and 60 use them as protection. Providers recommend that anyone – regardless of age – should be tested for several STDs before engaging in sex with a new
Alcohol or drug abuse
Persons who pay for sex
Injection drug users
Men who have sex with men
partner. And that includes both partners. A person may be sexually involved with only one person, but if that person is having sex with three others, the risk of exposure is tripled. A clean slate is the first step in a monogamous, or single-partner, relationship. Testing should include all STDs because it’s not uncommon for these infections to come in pairs or even triplets. The CDC found that there is biological evidence that the presence of other STDs increases the likelihood of both transmitting and acquiring HIV. The CDC recommends that everyone be tested once for HIV. Those who engage in risky sexual behavior, however, should add HIV, chlamydia, gonorrhea and syphilis to their yearly screening tests.
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FEAR OF FALLING “I’ve fallen and I can’t get up” was a line spoken in a TV commercial by LifeCall to persuade senior citizens to purchase its medical alarm and protection service. Although a dramatization of a very serious situation, the acting was so bad, the commercial evoked laughter instead of sympathy for the victim. But falls in the elderly are no laughing matter. And, they are very common. One third of adults aged 65 and older fall each year, according to the Centers for Disease Control and Prevention (CDC) often with dire consequences. Falls are the leading cause of nonfatal injuries among the elderly and result in $30 billion in direct medical costs a year. Falls account for almost all cases of hip fractures and traumatic brain injuries. Many do not fully recover and require long-term care and lose their independence. Loss of independence is not the worst outcome. Falls are the leading cause of deaths from injuries. In Massachusetts in 2010, falls accounted for the most injury deaths in residents older than 65, as noted in Massachusetts Deaths 2010, a publication of the Massachusetts Department of Public Health. The numbers increase with age. By the age of 85 more than half of injury deaths were caused by falls. People don’t fall because they get older. Rather, underlying factors, many of which are avoidable, are the culprits behind a tumble. For instance, muscle weakness, particularly of the legs, is one of the most important risk factors. Neurological or orthopedic conditions such as arthritis of the knee can offset one’s balance when least expected. Poor vision, confusion and medications can also cause the problem. Poor balance is a significant risk factor. People might complain of dizziness or vertigo, the feeling that the room is spinning. It is not well understood why balance begins to decline with age. What is known is that good balance relies on sensory input from the inner ear, eyes and sensors that provide feedback on the position and movement of the legs and feet. The elderly are prone to a variety of illnesses, such as diabetes and glaucoma that affect these systems. Balance is also dependent on good muscle strength and joint mobility, which are compromised by diseases of the bones and muscles. Just one fall can have a long-term impact. Older people who have fallen often are so afraid of falling again that they limit their activities, which sets in motion a vicious cycle. They lose mobility and muscle strength thereby exacerbating the risk of falling again. More than half of all accidents occur in the home, according to NIHSeniorHealth, an online publication of the National Institute on Aging. Poor light• Confusion ing, slippery floors and other hazards are constant threats. In addition, most falls are • Medications not the result of unusual or trick moves. Rather, they happen while • Poor balance doing normal daily activities. To remain up• Slow reflexes right elders are advised to do a home • Poor vision and progressive lenses safety check as well as a health check. • Muscle weakness, especially in the legs
Falls are the leading cause of injury deaths in the elderly
Causes of falls in older adults
• Sensory problems, such as numbness in the feet • Sudden drop in blood pressure upon standing or after meals • Unsafe home environment, such as clutter, steps or poor lighting 14 Be Healthy | Healthy Aging
CHECK YOUR RISK FOR FALLING Please circle “Yes” or “No” for each statement below. I have fallen in the past year. I use or have been advised to use a cane or walker to get around safely. Sometimes I feel unsteady when I am walking. I steady myself by holding onto furniture when walking at home. I am worried about falling. I need to push with my hands to stand up from a chair. I have some trouble stepping up onto a curb. I often have to rush to the toilet. I have lost some feeling in my feet. I take medicine that sometimes makes me feel light-headed or more tired than usual. I take medicine to help me sleep or improve my mood. I often feel sad or depressed.
Yes
No
2
0
Yes
No
2
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Yes
No
1
0
Why it matters People who have fallen once are likely to fall again. People who have been advised to use a cane or walker may already be more likely to fall. Unsteadiness or needing support while walking are signs of poor balance. This is also a sign of poor balance. People who are worried about falling are more likely to fall. This is a sign of weak leg muscles, a major reason for falling. This is also a sign of weak leg muscles. Rushing to the bathroom, especially at night, increases your chance of falling. Numbness in your feet can cause stumbles and lead to falls. Side effects from medicines can sometimes increase your chance of falling. These medicines can sometimes increase your chance of falling. Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls.
Total _____ Add up the number of points for each “yes” answer. If you scored 4 points or more, you may be at risk for falling. Discuss this brochure with your doctor. Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control behealthy.baystatebanner.com 15
T N O R F N I T O O ONE F R E H T O E H T OF prevent Having good balance can yday falls and help make ever activities easy and safe. ercises to Practice the following ex lance. improve and maintain ba
Stand on One Foot 1. Stand on one foot behind a sturdy chair, holding on for balance. 2. Hold position for up to 10 seconds. 3. Repeat 10-15 times. 4. Repeat 10-15 times with other leg. 5. Repeat 10-15 more times with each leg. TIP: For an added challenge, you can modify this exercise by not holding on or doing the exercise with your eyes closed.
Balance Walk 1. Raise arms to sides, shoulder height. 2. Choose a spot ahead of you and focus on it to keep you steady as you walk. 3. Walk in a straight line with one foot in front of the other. 4. As you walk, lift your back leg. Pause for 1 second before stepping forward. 5. Repeat for 20 steps, alternating legs.
Source: National Institute on Aging, National Institutes of Health 16 Be Healthy | Healthy Aging
Heel-to-toe Walk 1. Position the heel of one foot just in front of the toes of the other foot. Your heel and toes should touch or almost touch. 2. Choose a spot ahead of you and focus on it to keep you steady as you walk. 3. Take a step. Put your heel just in front of the toes of your other foot. 4. Repeat for 20 steps. TIP: If you are unsteady on your feet, try doing this exercise near a wall so you can steady yourself if you need to.
FALL-PROOF YOUR HOME Most falls occur in the home and while doing simple everyday activities. However, easy changes can be made to make the home safer.
LIGHTEN UP • Turn on lights before going up or down stairs • Place night lights in the bedroom, bathroom and hallways • Place a lamp within easy reach of the bed • Store flashlights in easy-to-find places in case of power outages • Use the highest wattage recommended for light fixtures
RE-ARRANGE • Arrange furniture to give plenty of walking room • Remove clutter • Place pet bowls, electrical or phone cords out of walking area • Remove objects from stairs and hallways Source: NIHSeniorHealth
HOLD ON • Have handrails installed on both sides of stairs • Use grab bars in tub or shower or next to toilet, if necessary • Use shower chairs or bath benches
TACK IT DOWN • Remove throw rugs • Attach rugs to the floor with double-sided tape • Use non-slip strips on floors and steps • Place rubber mats on floor of tub or shower
MISCELLANEOUS • Clean up spills right away • Use non-skid wax • Wear low-heeled shoes • Store foods, cans and dishes within easy reach to avoid the need for step stools
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T’AI CHI: KEEP YOUR LIFE IN BALANCE Master Heg Robinson demonstrates the t’ai chi pose Repulse the Monkey.
18 Be Healthy | Healthy Aging
Dorothy Frederick, Nicholas Locker and Adonica Chaplain (left to right) practice a t’ai chi pose with Master Heg Robinson. (Ernesto Arroyo photos)
Adonica Chaplain is the new kid on the block. She’s been practicing t’ai chi (tie chee) with Master Heg Robinson for only a few months while others in the class have 10 years or more under their belt. At 67, she is 20 years younger than many of her classmates. The fact that she’s in the class at all is in itself quite an achievement. “I hate exercise,” she confessed. “I’d join a gym, go for a month and not go back.” Even walks in idyllic Franklin Park could not hold her interest or attention. When Chaplain’s 82-year-old aunt asked her to join the class with her, she agreed. “She told me how it made her feel,” she explained. “I’ll give it a try.” A funny thing happened to Chaplain. T’ai chi accomplished what no gym or walking trail could achieve. She actually likes it. When Robinson took off the month of July for vacation, she missed it. August could not come fast enough for her. Robinson practices and teaches t’ai chi ch’uan, an ancient Chinese martial art that uses rhythmic movements, meditation and breathing for health and self-defense. T’ai chi consists of a series of gentle, deliberate movements that flow into body positions called “forms.” Students must focus on their breathing and technique rather than strength and power, al-
though good muscle control is required to complete each form satisfactorily. The movements of t’ai chi are deceptive. Though slow, depending on the intensity, they can be equivalent to a brisk walk or vigorous weight training. Heg has studied with several masters for many years and now teaches out of his academy in Roxbury and at the Melnea A. Cass Recreational Complex, part of the Massachusetts Department of Conservation and Recreation. “It works on the mind, body and spirit,” he explained. “It improves balance, posture and can help control diabetes and high blood pressure. It increases strength, stamina and coordination.” While aerobic and strengthening exercises are recommended for people of all ages, activities to improve flexibility and balance are also important, particularly for the elderly to help prevent falls, which can result in hip fractures. That is why a large percentage of Robinsonst’s students are elderly. The master ticked off other advantages of t’ai chi. For one thing, it is practical. “Anyone can do it at any age,” he said. “You don’t have to be athletic and you don’t have to wear special clothes. You can practice it anywhere — and if you do it right, you won’t pull a muscle or break a bone.”
You don’t have to convince Chaplain. She’s now a convert. She even likes the warm up exercises, but it’s what she and her aunt call the “dance” that gets her going. The dance refers to the t’ai chi forms. “It’s a beautiful thing,” she said. Chaplain said she has received a benefit from the exercise she did not expect. She was diagnosed with osteoporosis, or bone weakness, several years ago and takes medicine for the condition. She said that her last bone density test, which measures bone strength, for the first time in years showed an improvement. Although her doctors credit the medicine, she’s not quite convinced. In her opinion it’s the t’ai chi. Some studies on the health benefits of t’ai chi are contradictory, but there are two areas on which there is strong agreement. There is clear evidence that the exercise is effective for fall prevention. A study published recently in the New England Journal of Medicine found that t’ai chi appeared to reduce balance impairments in patients with mild to moderate Parkinson’s disease. Good balance reduces the risk of falls. The other area of agreement is improvement in psychological health. Chaplain can attest to that. “I feel good afterward,” she said. behealthy.baystatebanner.com 19
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20 Be Healthy | Healthy Aging
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CHALLENGE TO HEALTHY EATING
Brenda A. Carson/iStock/Thinkstock photo
The mantra for healthy eating does not change as the years pass: eat fruits and vegetables, whole grains, low-fat proteins and healthy fats. “General nutritional concepts remain the same across the age span,” said Kerry Ann Mendes, the dietitian at Whittier Street Health Center. Kerry Ann Mendes, However, other changes that M.S., R.D. Dietitian come with age may influence apWhittier Street Health Center petite and impair good nutrition. “There are sensory changes,” explained Dr. Monera Wong, associate chief of Geriatric Medicine at Massachusetts General Hospital. A reduction in the sensitivity of the taste buds can make food taste bland. Diminished sense of smell and vision add to the problem. “Our enjoyment of eating is greatly influenced by how foods smell and look,” she explained. With a loss of appetite, a picture begins to evolve of the challenge to ensure good nutrition in the elderly. For those who lose their appetite, Mendes recommends eating more frequent small meals — five mini meals will do — and healthy snacks, such as fruits and nuts throughout the day. In addition, some nutrients are harder for older people to consume and absorb. Vitamin D is one such example. Vitamin D helps the body absorb calcium, maintain bone density, or strength, and reduce the risk of osteoporosis. Research is ongoing to determine the vitamin’s impact on several chronic diseases, such as diabetes and heart disease, both common among the elderly. Formation of vitamin D is a complex process that requires cooperation among the sun, skin, liver and kidney. However, darker skin does not readily absorb the sun’s rays. Also, in the North the sun is not strong enough for a large part of the year to set the process in motion. In addition, there’s evidence that older people are less efficient vitamin D producers than younger people. A further complication is that few foods are a natural source of vitamin D. Examples are salmon and other fatty fish and fortified juices and cereals. Vitamin D’s cohort for maintaining strong bones is calcium, a major source of which is dairy products. “Lactose intolerance increases with age,”
NUTRIENT
DAILY INTAKE
SOURCES
Vitamin D
600 IU to age 70; 800 IU 71 and older
Salmon, tuna, fortified foods
Calcium
1,200 mg for women 51 and older and men 71 and older
Yogurt, milk, leafy greens
Vitamin B12 2.4 mcg
Fish, meat, milk products
Source: Office of Dietary Supplements
explained Mendes. “You have to find alternatives, such as calcium-fortified cereals and orange juice and leafy greens.” The Institute of Medicine recommends 1,200 milligrams of calcium a day and 600 to 800 IU of vitamin D a day for seniors. Vitamin B12 is another vitamin that is harder to absorb with age. Vitamin B12 helps create red blood cells and DNA and maintains healthy nerve function. However, many older people experience a thinning of the stomach lining or other digestive disorders that hamper the absorption of the vitamin. Sometimes even eating foods high in vitamin B12, such as fish, meat and milk is not enough. A supplement may be required. It’s not only what people eat. What one drinks is equally important. “Two liters (estimated 2 quarts) a day is the recommended minimum, Mendes explained, but some people never approach that amount — and often on purpose. Some seniors decrease their water intake, particularly if they’re on medication that increases urination. They drink less so they don’t have to be tied to the bathroom. An additional problem is the apparent slow-down of the metabolism in some seniors. Some experts, however, contend that one’s metabolism remains fairly stable throughout life. What actually occurs is a decrease in muscle mass accompanied by an increase in the amount of fat, which results in a lower resting metabolism. In turn the body burns fewer calories. A lower resting metabolism has to be countered by decreased consumption of calories and increased regular exercise to maintain a healthy weight. That does not always happen. “Older people are more sedentary and have conditions like arthritis that slows people down,” said Mendes. Almost 40 percent of adults 60 and over are obese, according to the latest figures from the Centers for Disease Control and Prevention. Excess weight in the elderly is linked to an increased risk of a myriad of health conditions, including high blood pressure and cholesterol, diabetes, osteoarthritis and even cancer,. Advice to the elders is often a family affair, but that’s not always a good thing, she explained. Some family members say “Grandpa needs to get healthy” while others have the attitude “Grandpa is old and can eat anything he wants.” Mendes is clear on one point. There is variability among the status of elders. It’s the lifestyle changes that often dictate how healthy an older person remains. “Those who are still active and have a healthy weight have fewer problems,” she explained. behealthy.baystatebanner.com 21
WHAT’S FOR DINNER? There is not one eating plan for all to follow. The types and amount of food depend on a person’s age, gender, weight, level of physical activity and medical condition. The choice of nutrients is up to you. The point is to choose wisely from each food group — maximize consumption of fruits, vegetables and whole grains while minimizing fatty meats and dairy products, unhealthy fats and sodium. A general rule is to make half your plate fruits and vegetables and the other half whole grains and low-fat protein. Water is a better choice than sugar-sweetened drinks. It is also important to balance the intake of calories with the calories the body uses daily. Consuming more calories than needed leads to weight gain. Healthy eating therefore should be combined with moderate exercise — 30 minutes a day at least five days a week. Ten-minute sessions several times a day are fine. Below is an example of a healthy eating plan for a 75-year-old sedentary woman. The plan from Choosemyplate.gov is based on roughly 1,600 calories a day and shows the recommended number of daily servings for each food type as well as examples of serving sizes. The American Heart Association recommends limiting sodium to 1,500 milligrams, or roughly half a teaspoon, a day for older adults, African Americans and those with high blood pressure. Added sugars should not exceed 6 teaspoons for women and 9 teaspoons for men a day. Remember that one’s particular plan will change according to personal taste, lifestyle and health care needs.
How many calories do people over age 50 need each day? A woman: • who is not physically active needs about 1,600 calories • who is somewhat active needs about 1,800 calories • who has an active lifestyle needs about 2,000-2,200 calories A man: • who is not physically active needs about 2,000 calories • who is somewhat active needs about 2,200-2,400 calories • who has an active lifestyle needs about 2,400-2,800 calories Source: http://www.nia.nih.gov/health/publication/ healthy-eating-after-50
WHOLE GRAINS 5 SERVINGS
DAIRY 3 SERVINGS
Sample serving
Sample serving
1 slice whole wheat bread
1 cup non-fat yogurt
½ cup brown rice
1 cup non-fat milk
1 cup dry cereal
1 ½ ounce cheddar cheese
VEGETABLES 2 CUPS
PROTEIN FOODS 5 OUNCES
Sample 1 cup equivalent
Sample one ounce serving
1 cup collard greens
¼ cup cooked beans
2 cups lettuce
1 to 5 ounces salmon
1 large ear of corn
2 tablespoons hummus
FRUIT 1 ½ CUPS
HEALTHY OILS 5 TEASPOONS
Sample 1 cup equivalent
Sample serving
1 large banana
1 teaspoon olive oil
1 large orange
25 almonds (estimate)
½ cup raisins
1 teaspoon salad dressing
For more information: USDA Food and Nutrition Information Center, 301-504-5414, www.nal.usda.gov/fnic National Institute on Aging Information Center, 800-222-2225, www.nia.nih.gov, www.nihseniorhealth.gov 22 Be Healthy | Healthy Aging
It’s well known that vitamin D, in conjunction with calcium, is essential for strong bones. That is why the Institute of Medicine recommends a daily dose of 800 IU of vitamin D for adults 71 and older, and 600 IU for adults younger than 71. Many doctors, however, recommend levels closer to 1000 IU. Unlike other vitamins, Vitamin D is not readily available in foods. Rather, its main source is the sun. Salmon is one of the top food sources of the vitamin. Just three ounces of sockeye salmon offer 450 IU or roughly half the daily requirement.
GINGER HONEY GLAZED SALMON WITH WHOLE GRAIN RICE AND SUGAR SNAP PEAS 4 servings | About $3.69 per serving ½ teaspoon ginger, peeled and grated (or ¼ tsp. dried)
1. Preheat oven to 450° F. In a large bowl, combine ginger, garlic, vegetable oil, soy sauce, honey, lemon juice and basil and add fish. Marinate in refrigerator for 10 minutes.
1 teaspoon fresh garlic (about 1 clove) or from jar, minced
2. Prepare rice according to instructions on package, excluding any salt or oil.
2 teaspoons vegetable oil 2 teaspoons low sodium soy sauce 1 teaspoon honey 2 teaspoons fresh lemon juice (about ½ lemon) or from the jar 2 tablespoons fresh basil (or 6-8 leaves), chopped (or 1 tbsp. dried) 1 pound salmon, skin removed, cut into 4 - 4 oz. filets
3. Cut 8 pieces of aluminum foil wide enough to fit one piece of salmon and ½ cup of snap peas. 4. Remove fish from marinade and discard remaining marinade. Arrange lemon slices on top and bottom of fish filet. Place one fish filet and half of snap peas together on one piece of foil. 5. Cover with another piece of foil and tightly fold together top and bottom edges of foil to create a seal to the steaming pouch. Repeat for second portion. Place on baking sheet and bake for 12 minutes. 6. Carefully cut open pouch and remove contents. Put salmon and snap peas over rice and serve.
Per serving: Calories 247
Cholesterol
53 mg
Total Fat
6.0 g
Sodium
158 mg
1 cup (dry) brown rice
Saturated Fat
1.0 g
Carbohydrates
20 g
2 cup fresh sugar snap peas
Trans Fat
0.0 g
Dietary Fiber
2g
Polyunsaturated Fat
1.5 g
Total Sugars
2g
Monounsaturated Fat
2.0 g
Protein
27 g
8 thin lemon slices (about 1 small lemon) Aluminum foil
Source: American Heart Association’s Simple Cooking with Heart® Program. For more simple, quick and affordable recipes, visit heart.org/simplecooking.
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