From younG to olD

How can young men increase their chances of becoming old men? And more importantly, healthy and dynamic old men?

What should middle-aged men do to avoid making their wives widows? And how can old men improve their enjoyment of their autumn years? Let’s take a look at the challenges facing men throughout their lifespan as they try to maximize both the length and quality of their lives. While basic principles like not smoking, exercise, and avoiding substance abuse apply at all ages, the emphasis evolves as a man ages.

Up to age 35, violent death is the number one killer of men. And the number one way young men die violently is either behind the wheel or as a passenger in a car wreck. Homicide, suicide, and sporting injuries are also relatively common in this age group. A key feature of youth is a sense of invulnerability, which sadly is an illusion, as demonstrated by accident statistics. Many of these tragic deaths could be avoided by simple rules such as wearing helmets when driving motorcycles or bicycling, buckling up 100% of the time, and of course never driving under the influence. Cancer is another concern for young men, although in general the risk of cancer increases with age. That is not true for testicular cancer, which is the #1 cancer of men up to age 40 after which the incidence decreases. For this reason guys are advised to check their testicles in the shower on the first of each month and to report any lumps found to your doctor without delay. Fortunately this disease is almost always curable. Skin cancer, particularly among fair skinned men is another major cancer killer and one that is easily prevented by avoiding sunburns and using sunscreen when exposed to the hot sun for any extended period of time. Around 20 minutes of sun exposure may actually reduce the risk of cancer by boosting vitamin D levels, but again, it is important to avoid burning.

In terms of vaccination, traditionally the only one recommended up to age 65 had been a tetanus booster every ten years. Flu shots, formerly recommended for about 80% of the public, are now recommended for everyone. This is good policy. Many people fear the flu shot, but I’ve had influenza twice and I fear it more than the shot. As a health care worker, I get the shot every year and never have a bad reaction from it. Anyone self-employed who can’t afford to lose a week from work should have one, because influenza takes a week out of your life, assuming you are not one of the 30-50 thousand Americans who die of influenza every year. Fathers of young children, partners of pregnant women - both of whom are especially vulnerable to serious illness or death from influenza - men with asthma or other heart or lung problems, and men with compromised immune systems should all have annual flu shots, but I agree with the recommendation that everyone get one. We have seen previously healthy teens die of influenza, and such deaths can be prevented with the flu shot.

In middle age, men need to pay attention to cardiovascular risk factors as heart disease remains the overall #1 killer of men, and the risk increases with age. Again, most heart disease is preventable. Staying fit, not smoking, eating well, controlling risk factors such as high cholesterol and high blood pressure, and maintaining a healthy weight are all powerful and effective ways of avoiding the #1 killer. For those who do have high blood pressure or high cholesterol not responsive to diet and exercise, excellent drug therapies are available from your primary care provider and have been shown to save lives. Not smoking - one of the keys to long life and good health - and good diet are also powerful ways to reduce the risk of the #2 killer, cancer. And the same rules apply at every age when it comes to reducing the risk of premature accidental death: never drink and drive, always buckle up, and always wear a helmet on bicycles and motorcycles.

A word about alcohol is appropriate here as cirrhosis of the liver is a leading cause of death in middle-aged men. I learned at a young age that Jesus turned water into wine at Canaan - not wine into water! It turns out that the much-touted health benefits of red wine are actually the benefits of alcohol. Spirits and beer have been shown to have the same health benefit, promoting longevity in moderation. What is moderation? No more than two drinks per day. As I tell my patients, 2 drinks per day does not equal 14 on Friday night! It turns out that the health benefits of moderate alcohol consumption come from frequent, low level drinking, i.e. one or two drinks per day. More than this is actually bad for health and can shorten your life. Remember, one drink is 1.5 ounces of spirits, 4-5 ounces of wine, or 12 ounces of beer.

For older men, coronary disease and cancer remain the top two killers, each accounting for around 25% of all deaths. Pneumonia, influenza, chronic lung disease, diabetes, cirrhosis, and suicide are all major killers as well. At age 65, all men should have a vaccination against pneumonia and those with serious heart, lung, or immune system problems should have it earlier. Annual flu shots and pneumonia vaccine save countless lives every year. As always, one cannot be healthier than their diet, so a diet low in animal fats, high in whole grains, vegetables, seafood, and fruit will contribute to less chronic illness and hence a more enjoyable old age. And of course, smoking is slow suicide, so if you smoke - quit! Your doctor can help you with a variety of proven strategies including medication, nicotine replacement, and moral support. Its never too late, indeed the risk of heart attack from smoking is virtually gone within two years of smoking and the risk of cancer, while not gone, is greatly reduced.

The right mental attitude is important throughout life, but tragically, the risk of suicide increases dramatically as men age. Men typically identify with their career and role as bread-earner, so retirement with the loss of these roles can be a burden on some older men. It has been shown that social connectedness is an important determinant of health in general, so the loss of friends and other loved one with advancing years can be devastating. It follows that maintaining social contact through friends, family, church, synagogue, or mosque, volunteering, etc. can be literally life saving. We all need friends and trusted advisors who sometimes make life itself possible, not to mention more enjoyable.

Physical activity remains important throughout life, not only for long life but also for good life. Don’t be like George Burns who said “if I had known I was going to live this long, I would have taken better care of myself!” Walking, swimming, and cycling either outdoors or more likely on a stationary bike are all activities that can help keep a man mobile and independent into advanced old age. My own Dad rode his bike up to age 86 and was as dynamic mentally and physically as he was at half that age.

To summarize, no one wants to age before their time and fortunately there is much one can do to prevent his. The chief ways to accomplish this are to exercise, eat well, don’t smoke, don’t abuse drugs or alcohol, maintain a health weight, and stay connected to family, friends, and the community at large. None of these involve medical care, but preventive medicine is always the best kind, so seeing a doctor or other primary care provider for regular check ups to monitor and control such things as cholesterol and blood pressure and staying up to date on immunizations can be life saving. For those 50 and older, colonoscopy to screen for bowel cancer - the number 2 cancer killer after lung cancer, and screening for the commonest internal cancer of all - prostate cancer - can save lives. For more on prostate cancer, see my article in the last issue of Breathe In.

David C. Dodson, M.D., a primary care physician with Sansum Clinic, is Chair of the Committee on Men’s Health and a member of the Committee on Nutrition and Physical Activity of the Massachusetts Medical Society.