Pilot Media - Caring For The Aging 2015

THE VIRGINIAN-PILOT | A SPECIAL ADVERTISING SUPPLEMENT | WEDNESDAY | 06.24.15

Caring for the aging DENNIS TENNANT FOR THE VIRGINIAN-PILOT

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WEDNESDAY, JUNE 24, 2015

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index Staying fit into your golden years Page 6

How to love your retirement: Staying in shape Page 7

Can a building make you better?

Page 8

Hope for Alzheimer’s treatment, prevention Page 12

The secret of the centenarians Page 14

Are you at risk of dying within the next five years?

One quiz might be able to tell you.

Page 18

about the section Editor Clay Barbour clay.barbour@ pilotonline.com Advertising (757)222-5538, PilotMedia Solutions.com Designer Lisa Merklin lisa.merklin@ pilotonline.com Reporters Alison Johnson Kim O’Brien Root Cindy Butler Focke

TOO MANY BOOMERS, NOT ENOUGH DOCTORS The number of aging patients is outpacing that of geriatric doctors trained to treat them.

Story by ALISON JOHNSON Correspondent Photography by DENNIS TENNANT For The Virginian-Pilot

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NORFOLK

EDIATRICIANS ARE FOND of saying that children are not just smaller adults. Turns out, people 65 and older aren’t just grayer adults, either. ¶ Seniors face more complex health challenges, often have markedly different symptoms for common killers and respond uniquely to medications, especially those that increase the risk of mental confusion and falls. ¶ Unfortunately the number of doctors specializing in elderly care lags far behind the number of people aging into that demographic.

See GERIATRICS, PAGE 4

Dr. Robert Palmer, right, talks with Amarsit Singh during Singh’s visit to the Glennan Center for Geriatrics and Gerontology at EVMS. Palmer sees Singh on a regular basis.

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GERIATRICS Continued from Page 2

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“There’s a huge disconnect,� says Dr. Marissa Galicia-Castillo, professor of geriatrics at Eastern Virginia Medical School in Norfolk. “Beyond the shortage of doctors just in general, far too few are going into geriatrics. It’s especially concerning given that the fastest growing portion of the senior population is 85 and older. Cookie-cutter care is not going to work.�

Nearly a fifth of Virginians are expected to be older than 65 by 2030, up from 12 percent in 2010. The state would need 790 certified geriatricians to properly care for the most needy patients, according to the American Geriatrics Society. As of 2014, it had 185, a number that has barely moved in recent years.

On a good year, about 100 med-

ical school graduates in the United States choose the field. That doesn’t surprise Galicia-Castillo, who says EVMS produces about one a year, a trend the school is fighting to change.

Diagnosing older patients is rarely straightforward. A 75-year-old having a heart attack might present with extreme fatigue, nausea or delirium, rather than chest pain. Delirium also can be a sign of pneumonia or a urinary tract infection, health problems that would present as fever in younger patients.

Elderly patients are often more susceptible to side effects of certain medications, says Dr. Brad Murray, an EVMS geriatric fellow. Murray often finds himself trying to wean patients off drugs they’ve taken for decades that have become ineffective or

Dr. Brad Murray and Connie Mix share a laugh at the beginning of Mix’s visit with Murray at the Glennan Center for Geriatrics and Gerontology at EVMS in Norfolk.

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Continued from previous page

potentially dangerous.

“Their bodies can metabolize medications differently, which may impair mental function and lead to more falls,” he says.

“They also may just be making people feel worse.”

Most geriatricians complete an extra one or two years of specialized training to prepare for the job. One huge roadblock to recruitment -- especially for graduates in significant debt -is that the field generally pays less than other specialties with advanced training. Geriatricians work mainly with Medicare patients.

Local educators are now training all medical students in the basics of geriatric care, given that many will handle a senior-heavy patient population no matter their specialty.

They’re also developing nurses and physician assistants to help.

“There is a real opportunity for us to step up and fill some of the void,” says Christianne Fowler, a geriatric nurse practitioner and assistant professor at Old Dominion University.

ODU has a standalone geriatrics course for undergradu-

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ates studying to be registered nurses; a class on aging became a requirement for graduatelevel nursing students three years ago.

EVMS has since 2004 offered a combined geriatrics-internal medicine track designed to expose more students to the field earlier in their training.

Caring for the elderly also requires a shift in mindset for students, most of whom expect to focus on extending lives.

“What I’ve found is most older patients really don’t fear death,” Fowler says. “They’re afraid of disability, of outliving their money and becoming a burden. They want quality of life, and there are many little changes we can make -- whittling down their medications, tweaking their diets -- that can make a big difference.”

Geriatrics uses a team approach that draws in social

workers, nutritionists, neuropsychologists, pharmacists and other experts to address mobility, cognitive function, family support, transportation and retirement finances. “It’s not a ‘sexy’ field, but you get to spend a lot of time with patients and have really in-depth, meaningful discussions,” says Murray, who will practice on the Eastern Shore come fall. “You can make a lot of progress.”

Joyc e B a rge , a C h e s a peake resident who brings her 82-year-old mother to EVMS’ geriatric consultation clinic, can vouch for that. Ernestine Brooms suffers from dementia, diabetes, high blood pressure and arthritis and lives with her daughter. Since she began seeing Murray about a year ago, she is on fewer medications and is more physically active.

“She likes the office because nothing is rushed or crowded,”

One huge roadblock to recruitment in geriatrics – especially for graduates in significant debt – is that the field generally pays less than other specialties with advanced training.

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Barge says. “People take their time and talk to her. They monitor everything.” The progress has helped Brooms stay with Barge rather than in a health care center: “Her diabetes is better. We’re not waiting on her as much because she’s moving around more and they encourage that. She eats better. I’d say most definitely she’s feeling better.”

As medicine moves away from a fee-for-service model in favor of rewarding good outcomes for patients, Murray is hopeful that geriatrics will attract more medical students.

Increasingly, geriatricians are practicing outside of long-term care centers and moving into leadership roles in hospitals and medical practices, he notes.

They also report some of the highest job satisfaction rates in medicine.

Yet as of now, EVMS has no young doctor to fill its fellowship in geriatrics – the one Murray just completed – for the fall.

“We need to remember that these patients are someone’s mom, someone’s dad, someone’s loved one,” Galicia-Castillo says. “They deserve our best.”

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DENNIS TENNANT | FOR THE VIRGINIAN-PILOT

Dr. Brad Murray walks down the corridor with Betty Malik to assess her balance and mobility during Malik’s clinic visit

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Staying fit into your golden years

By Kim O’Brien Root Correspondent HAMPTON

Inside a large exercise room at the Hampton YMCA, about 45 people are lined up before instructor Robbie Koll, following her as she salsadances back and forth.

Near each of them is a chair, but except for one man, the entire class is on its feet, shaking and shimmying along with Koll.

The 93-year-old woman who broke her pelvis last year? She’s standing.

The man with early onset Alzheimer’s? He’s right up front. And the couple in their 80s, who have been going to the YMCA for 20-some years? They’re right up there, too, dancing.

“Seniors?” calls out Koll. “What seniors?”

This is SilverSneakers, a national exercise program for older adults.

The Hampton YMCA, one of 13,000 locations offering the class, has hosted it for 11 years. It is one of the center’s best attended classes.

Free for many seniors, the program is available through health plans, including Medicare. In Virginia, SilverSneakers is offered through the AARP Medicare Supplement Insurance Plan, Aetna Medicare, Anthem Blue Cross and Blue Shield, Anthem HealthKeepers, Humana and UnitedHealthcare.

SilverSneakers’ classes are intended to help participants age gracefully and healthily. The total-body conditioning classes are designed to increase muscular strength, endurance, range of movement, flexibility, balance, agility and coordination.

“The more mature people are very interested in keeping their health, like a preventative maintenancetype of thing,” Koll says. “We have a lot of seniors who lose weight when they start, but more importantly are the other health issues. It helps with the heart, with diabetes. A lot of them come in and say, ‘Our doctor is just so proud of us.’ And I’m proud of them.”

Koll, 70, a retired photographer from Poquoson, has taught aerobics at the location for about 20 years.

She started her SilverSneakers class with three people. Today, there are more than 60 enrolled, with classes meeting four times a week.

Any YMCA member can attend.

Koll sometimes gets younger attendees, many of whom are recovering

KIM ROOT | FOR THE VIRGINIAN-PILOT

SilverSneakers is a national exercise program for older adults. Hampton YMCA, one of 13,000 locations offering the class, has hosted it for 11 years.

If we don’t move, we won’t be as energetic. ... I don’t want to miss this class.”

Elvira Cooper, who helps teach the class

from injuries. But the class is anything but easy.

The chairs are in place for several exercises. Sometimes they’re used for balance.

Koll tells the participants they don’t have to stand – that they can make the class as light or as hard as they want. She once had a man in her class with an oxygen canister. Canes are a common sight.

Ginny Kilduff, 93, fell down a set of stairs last August, breaking her pelvic bone in three places. She had been taking the class before her fall, and resumed it as soon as she could.

“I need the exercise,” she says. “It’s important to keep moving.”

More than just exercise, SilverSneakers also provides social events for members. The class goes on frequent field trips. Members of the class say they can’t imagine not having it.

For 75-year-old Delores Cooper, it’s the feeling she gets from exercise that motivates her.

“If we don’t move, we won’t be as energetic,” adds Elvira Cooper, who helps teach the class on the rare occasions Koll can’t make it. “You still get the aches and pains. But you get renewed energy. I don’t want to miss this class.”

On a recent Thursday, the class was rocking to the music, many sing-

ing along, as Koll led them through the steps. Along the way, she shouted out encouragement, calling them by name, reminding them to drink water, joking with them as they stood with one hand on a chair to do leg lefts.

“Not too high,” she cautioned as Frank Sinatra crooned “Witchcraft” over the stereo speakers. “Nobody throw out their hip!”

The class just laughed along with her.

“When I’m here,” said Delores Cooper, “I don’t even think about being 75.”

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The ability to connect with the past is helpful for those who suffer memory loss. Shadow boxes for each resident hang on the wall outside each room. Family members place mementos inside them to help trigger reminders of important events. One room’s box features an old photo of a resident and her husband, a lipstick holder, and some small figurines.

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ASSISTED LIVING Continued from Page 9

dents are given the opportunity to participate in gardening, play word games, listen to music, and even bake cookies – a way to bring normalcy to their lives.

“We are trying to be innovative, and as much a part of their normal as we possibly can,” Jacobson said.

The local Alzheimer’s chapter provides free family services, programs, resources, plus a monthly family orientation for relatives of loved ones with the disease. For more information, visit www.alz.org/seva or call the 24-hour hotline, 800-272-3900.

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Family members fill Memory Boxes, located outside each room, with photos, poems and personal knick-knacks to help each resident remember where their room is.

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Researchers finally see hope for Alzheimer’s treatment, prevention

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Alzheimer’s disease is one of the conditions that Americans are most afraid they will get, second only to cancer. Yet at least a generation of focused research has gone by without an effective treatment or sure advice on how to prevent it.

University of Pittsburgh Alzheimer’s researchers are among those leading studies and while huge challenges still exist in making progress, they see hope in recent reports.

The new research is examining both treatment and prevention, using the latest technology of imaging a person’s brain. In addition to the changes in the way a person thinks, Alzheimer’s is associated with physical changes, including beta amyloid plaque and tau protein “tangles� in the brain.

Oscar Lopez, a professor of neurology at Pitt and director of the University of Pittsburgh Alzheimer’s Disease Research Center, said he is concerned that, despite improved technology, it will still take another 10 years to get useful results.

There are a handful of studies, including the multisite A4 Study at Pitt, that are examining people without any sign of Alzheimer’s and following them for 10 years with brain scans.

They hope this will explain why one person develops the disease and another doesn’t.

Dr. Lopez is the principal investigator in Pittsburgh. “We’ll follow them as they are normal, for about four to

five years; then symptoms begin to appear and dementia is diagnosed. Then we can understand these early scans and know how fast the disease progresses.�

Dr. Lopez also oversees the Pittsburgh arm of the ongoing global, multisite study known as ADNI. It is assessing information collected from cognitive tests, imaging, genetics and amyloid and tau biomarkers as patients are followed over several years through normal aging to diagnoses of mild cognitive impairment or dementia, including Alzheimer’s. This study will provide information about the individuals who are more vulnerable to develop Alzheimer’s disease. “Some people have amyloid processes but have no symptoms. Others have no amyloid,� Dr. Lopez said about questions researchers have. “What makes a person vulnerable? It is a chemical connection; does stiffness in the arteries correspond to amyloid in the brain? We now know that hypertension is connected to Alzheimer’s.� “ Watchi ng people go through aging takes time,�

Dr. Lopez said - and money. “Even with all the technology (to aid research), there is still the human factor ... you need to follow people through the aging process. The whole process will take two generations.�

In the meantime, National Institutes of Health funding for Alzheimer’s research is not keeping up with the need, he said, and that is discouraging young scientists. “We lost one genera-

tion of researchers. That’s significant damage.�

Technology, in particular, is costly, Dr. Lopez said.

Armed with new technology, recent studies point to malfunctioning tau as the main cause of the decline in thinking and memory in Alzheimer’s, not the buildup of beta amyloid fragments in the brain, which has been the focus of research for more than 20 years.

The good news is that achievements are being made in therapies a nd technology - and the public mindset is in the right place, said William “Bill�

Klunk, Pitt professor of psychiatry and neurology, and co-director of the research center. “We have reached the point where it’s worth the effort,� said Dr. Klunk, also chair of the Alzheimer’s Association Medical and Scientific Advisory Council, which guides the direction of the group’s research program. “The Alzheimer’s Association has worked hard with its collaborators, to draw attention to the need for more funding, and that has shown some success,� he said, adding that although more than $500 million for research was in this year’s federal budget, an additional $300 million is requested for next year.

The association pre dicts that without a medical breakthrough, by 2050 there will be 13.8 million Americans over age 65 with the disease. The likelihood of developing Alzheimer’s See next page

We’ll follow them as they are normal, for about four to five years; then symptoms begin to appear and dementia is diagnosed. Then we can understand these early scans and know how fast the disease progresses.�

Dr. Oscar Lopez, director of the University of Pittsburgh Alzheimer’s Disease Research Center

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Continued from previous page

doubles every five years after age 65. After age 85, the risk is almost 50 percent.

It’s not just amyloid or tau proteins, Dr. Klunk said. “In older people, there is more incidence of the disease, there are more pathologies in the brain, more protein deposits. There are subtle blood flow changes. All of these things change. It’s more likely that their Alzheimer’s disease is a combination of more than one thing going on in the brain.”

There are several trials at Pitt testing drugs to treat or prevent Alzheimer’s. Trials now recruiting include the A4 Study, which is testing a drug, given by IV infusion, that might prevent or delay the onset of Alzheimer’s in people who may be at risk, as seen in a brain imaging test known as a PET scan.

More information is available at a4study.org.

Four medications now are most frequently prescribed to treat the symptoms of Alzheimer’s disease: Aricept, Razadyne, Exelon and Na-

menda.

“Medications can slow down the progression of the disease,” Dr. Lopez said.

“The risk of going to a nursing home is diminished, but they’re not magic.”

In addition, plasma exchange is being tested at Pitt as a treatment of symptoms in patients with mild to moderate Alzheimer’s.

The unwanted amyloid proteins are removed from the blood and the plasma is returned to the body. It is only excess amyloid that gets to the brain that is a concern.

Also underway and not seeking more patients is a “passive immunization” study that tests doses of an antibody to clear beta amyloid from the brains of patients with mild to moderate Alzheimer’s.

Pitt is also part of a multisite international study of people who have a genetic risk for Alzheimer’s.

Known as the DIAN Trial, it is still recruiting and will assess safety of two drugs in people who have a genetic mutation for inherited earlyonset Alzheimer’s disease,

which makes up fewer than 1 percent of total Alzheimer’s cases.

“The game change is the anti-amyloid therapies themselves,” Dr. Klunk said.

“Without those antibodies or therapies or imaging technologies, none of these trials could exist.”

He said it’s a critical time now to see results: There are fewer companies, such as Eli Lilly and GE Healthcare, to pursue development of imaging tools and drug therapies.

Dr. Klunk said he was highly encouraged by recent news from drug company Biogen Idec, saying an experimental drug was found to slow down the decline of mental function in Alzheimer’s patients in a small clinical trial. The drug, aducanumab, was being tested for safety and not for dosage, but higher doses of the drug brought better results.

It is designed to clear amyloid plaque from the brain.

“Results might come in two or three years,” Dr. Klunk said. “We’ll see.” Dr. Klunk said.

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The secret of the centenarians AS MORE PEOPLE HIT THEIR 100TH BIRTHDAYS,

baby boomers and researchers seek the answers to what factors into a long life and how to age well.

By Erica Curless The Spokesman-Review

Just live. Perhaps that’s the secret to living to age 100 -- 20 years longer than the average life expectancy.

The idea was to have local centenarians give advice to baby boomers, the generation just younger than most of their children, on how to age well and hit the 100 mark.

Centenarians are still considered rare, but are becoming more common with advancements in medi-

cine and health care.

Yet by age 100, that sage advice is largely lost.

“Margaret, do you have any words of wisdom to tell us young gals and guys?” asked Elise Biviano, executive director of Brookdale Place at Northpointe in Spokane, Wash., during a recent 100th birthday celebration for Margaret Kunkel and Dorothy Kuhta.

“No,” Kunkel said, looking around blankly. She returned to See CENTENARIANS, PAGE 16

“I’d like to hope I have some of her genes.”

Dick Kunkel, whose mother Margaret recently turned 100

TRIBUNE NEWS SERVICE FILE PHOTO

Currently, people older than 85 make up the fastest growing segment of the U.S. population.

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CENTENARIANS Continued from Page 1

staying alive longer A 2008 CDC article lists â&#x20AC;&#x153;survival instructionsâ&#x20AC;? for the oldest of the old: Â&#x201E;

Stay active

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licking frosting off her fingers.

The facility threw a party for the ladies, born in 1915 during World War I when Babe Ruth made his pitching debut and the inauguration of transcontinental telephone service when Alexander Graham Bell called San Francisco from New York.

The women married in their early 20s, during the Depression years of the mid-1930s Family and friends gathered, drank Champagne, and ate cupcakes and fruit spears and sang â&#x20AC;&#x153;Happy Birthday.â&#x20AC;?

Mary Kunkel said later that she didnâ&#x20AC;&#x2122;t think her motherin-law grasped that it was her birthday party. Although healthy and vibrant looking, Kunkel hasnâ&#x20AC;&#x2122;t had many â&#x20AC;&#x153;good daysâ&#x20AC;? lately as far as her memory.

Thatâ&#x20AC;&#x2122;s part of aging, especially when you live to 100.

About 50 percent of U.S. centenarians have dementia and only 20 to 25 percent are cognitively intact, according to the U.S. Census Bureau.

Kuhta knew it was her birthday and enjoyed the party.

Swaying to the live music and enjoying the attention from television and newspaper reporters. â&#x20AC;&#x153;I have no secret,â&#x20AC;? Kuhta said with a big smile and shake of the head. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m just shocked.â&#x20AC;?

She said she never gave birthdays, or aging, a thought.

Then she added that she has a great family that â&#x20AC;&#x153;grew up together and vacationed together.â&#x20AC;?

Yet Kuhtaâ&#x20AC;&#x2122;s family was surprised she was so aware and engaged. They hadnâ&#x20AC;&#x2122;t seen her that vibrant in months.

Mia Walden, Northpointeâ&#x20AC;&#x2122;s sales and marketing manager, said the facility has had more than a â&#x20AC;&#x153;handfulâ&#x20AC;? of centenarians over the years and is seeing more all the time. Currently Northpointe has a high population of 97- and 98-year-olds, largely because the facility offers one of the highest levels of care in Spokane, Walden said.

Between 1980 and 2010, there was a 65.8 percent increase in the number of Ameri-

can centenarians, according to the Census Bureau. Currently, people older than 85 make up the fastest growing segment of the U.S. population.

Thanks to the baby boomers (1946-1964), from 2000 to 2030, the number of people 80 and older in the United States will double to 19.5 million, according to the Centers for Disease Control and Prevention. A 2008 CDC article, lists â&#x20AC;&#x153;survival instructionsâ&#x20AC;? for the oldest of the old: - Stay active - Eat right - Avoid tobacco - Have social networks - Do cognitive activities Itâ&#x20AC;&#x2122;s the same advice given for years. Yet longevity also requires resilience, which the article said in short means the ability to withstand stress. Selfreliance is a key factor of resilience, according to a Swedish study cited in the CDC article.

Both Kunkel and Kuhta have lived by these principles. They were both active and social.

Kunkel always worked and eventually became a real es-

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65.8% Between 1980 and 2010, there was a 65.8 percent increase in the number of American centenarians, according to the Census Bureau.

tate broker. Kuhta raised three boys, always ate healthy and started walking daily in her 50s. â&#x20AC;&#x153;Momâ&#x20AC;&#x2122;s healthier than Iâ&#x20AC;&#x2122;ll ever be,â&#x20AC;? said Kuhtaâ&#x20AC;&#x2122;s son Bob, 75, who has bad knees, two bouts with cancer and other health issues.

Dick Kunkel said his mom never thought she would live to her 90s, much less 100. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;d like to hope I have some of her genes,â&#x20AC;? said Kunkel, who recently retired as Spokane

Public Radio general manager.

Researchers are studying centenarians more as people live longer, attempting to pinpoint the biological, psychological and sociological traits that allow some people to live decades longer than the general population. The National Institute on Aging has reported that exceptional longevity tends to run in families. It is also supporting more studies to learn more about the secret to a long, healthy life.

Earlier this year, 115-yearold Jeralean Talley of Michigan became the worldâ&#x20AC;&#x2122;s oldest living person, according to the Gerontology Research Group.

Talley, who was born May 23, 1899, attributes her longevity to God. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s coming from above,â&#x20AC;?

Talley told the Detroit Free Press. â&#x20AC;&#x153;Thatâ&#x20AC;&#x2122;s the best advice I can give you. Itâ&#x20AC;&#x2122;s not in my hands or yours.â&#x20AC;?

Bob Kuhta has some other advice, perhaps learned from his mother. â&#x20AC;&#x153;One day at a time,â&#x20AC;? he said. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s just a good way to be.â&#x20AC;?

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Dear Friends, My mother, Gla dys, will be 87 she has been a re this June, and sident at The B allentine Assiste Living commun d ity for over 2 ye ars. Earlier this it became necess year ary to move her into memory ca but since the m re, emory care neig hborhood at Th Ballentine had e not yet been co mpleted, we mad the choice to m e ove her to a diffe rent community temporarily un til construction was completed.

The incredibly kind and compa The Ballentine’s ssionate staff at sister community , Commonwealth Memory Care at Norfolk, were no thing short of amazing during this stressful tim e. Directors Bay Armstrong and Jodie Agner and their wonderful staff gave my si sters, Karen and Cindy, and I su piece of mind in ch knowing our m other was properly cared for. Yesterday, th rough many hu and tearful good gs -byes, we left C ommonwealth move my mom to back to The Bal lentine. My mot was very emotio her nal as she had go tten very attach to the staff ther ed e over the past 2 months, and they to her. Man y were sad to se e her go but they understood that The Ballent ine was where she belonged.

I phoned ahead to let The Balle we were on our ntine know way back. Imag ine the look on mother’s face w my hen she, already in an emotiona fragile state, look lly ed up to see the staff standing outside, waving to greet her! It made her feel lik queen. They wer ea e so happy to ha ve my mom ba and the welcom ck ing party was ju st what she need to lift her spirits ed .

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At risk of dying within 5 years?

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Swedish scientists put together a questionnaire that factors in health to predict longevity

Abby Phillip The Washington Post.

What is your risk of dying in the next five years? A pair of Swedish researchers have created a short questionnaire that may provide an answer.

To understand how this works, it’s important to first consider a few caveats.

Correlation and causation are not the same. In this case, the researchers have highlighted correlations between risk of death and factors such as smoking and chronic health conditions. They aren’t foretelling anyone’s death.

Then there’s the question of who can use this tool to get an accurate result. If you are between the ages of 40 and

70 and you live in the United Kingdom, you are good to go.

Others may find the detailed study from which the quiz was derived more useful than the quiz itself, which can be found at ubble.co.uk.

There are several interesting findings that could help doctors, public health officials and regular people ask questions that may be relevant to one’s health and longevity, at least for the next five years.

For example, the researchers found that walking pace was a particularly strong predictor of death risk - stronger, they said, “than smoking habits and other lifestyle measurements.” The researchers found See next page

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... Quiz can tell you, researchers say.

Continued from previous page

that men age 40 to 52 who reported that their walking pace was “slow” were 3.7 times as likely to die within five years as those who reported a “steady average pace.”

The study was authored by Andrea Ganna, a biostatistician at the Karolinska Institute in Stockholm, and Erik Ingelsson, a professor at Sweden’s Uppsala University.

Their findings suggest that a short questionnaire might be a good supplement to or potentially a replacement for a standard physical examination for doctors and other health professionals to use in identifying people with high mortality risk.

The survey asks 13 questions of men and 11 of women. A 59-year-old man, for instance, is asked how many people live in his household and whether they are related; a 59-yearold woman is asked how many children she has had; the man is asked about how many cars are in his household, the woman isn’t; the man is asked about strokes, high blood pressure and heart attacks; the woman about nerves, anxiety, tension and depression. Questions for both sexes cover such topics as overall health, smoking habits, walking pace and whether a person has experienced illness, injury, financial difficulty, marital issues or the loss of someone close.

Some factors, such as psy-

chological and socioeconomic variables, were strong predictors of death causes unrelated to physical health, including suicide or accidental fall.

Among people who didn’t have major diseases, smoking habits were the strongest predictor of risk of death within five years. For men, the most common cause of death was lung cancer; for women, it was breast cancer.

Overall, the results are “reasonably good” predictors of death within five years, the researchers said.

To create the survey, the researchers used the UK Biobank, which collected hundreds of data points from nearly 500,000 Britons between 40 and 70. The research-

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ers said they are the first to look at such a wide range of variables in such a large group.

To assess an individual’s risk of dying within five years, the online quiz results are compared with nationwide data and the person is given an “Ubble age.” For example, if you are a 50-year-old man and the results of the survey give you an age of 56, that means your risk of dying is similar to that of a

56-year-old man in the United Kingdom. It then tells you what that five-year risk of dying is.

The findings have been published in the journal Lancet.

But this project is remarkable for how interactive and open it is. Anyone can use the tool to see how lifestyle and health factors affect risk of death.

People can also look at the association between certain risk factors and age.

Among people who didn’t have major diseases, smoking habits were the strongest predictor of risk of death within five years. For men, the most common cause of death was lung cancer; for women, it was breast cancer.

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