Geriatric EM Lifestyle Medicine for Older Adults: When is it too late?

Lifestyle Medicine for Older Adults: When is it too late?

By Raquel Harrison, MD, DipABLM and Mary Mulcare, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine

The “wellness” conundrum poses a challenge to health care; what makes one person well is very different from that which makes the next person feel equally well. Most approaches to wellbeing have been a series of narrowly focused point solutions that lack evidence.

Lifestyle Medicine (LM) has successfully changed the well-being landscape. The American College of Lifestyle Medicine has defined LM as the use of evidence-based lifestyle therapeutic interventions, including a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection. Clinicians certified in LM help people intentionally replace unhealthy behaviors with positive ones by identifying those behaviors that a person can easily integrate into their daily life. This approach to lifestyle addresses

“A skilled LM provider assesses the patient’s current state and meets them there, creating simple, feasible goals to move the patient towards a healthier state.” underlying causes of disease, not just symptoms — supporting overall wellbeing while preventing, treating, and often reversing chronic disease. When is it too late to bring LM into one’s life? It is never too late! A skilled

LM provider assesses the patient’s current state and meets them there, creating simple, feasible goals to move the patient towards a healthier state. The goal is nonpharmacologic intervention. The simpler and more personalized the goal, the more sustainable it becomes.

Six Pillars of Lifestyle Medicine

Briefly, the six pillars of LM can be interpreted in the context of older patients: 1. Nutrition: Plant-based diets have anti-inflammatory effects, reduce cardiovascular disease, and impact the onset of many common malignancies.

For patients suffering from constipation, nutritional adjustments can provide the motility enhancement needed. 2. Exercise: Moderate exercise in one’s routine reduces cardiovascular disease, obesity, diabetes, and improves brain health among other things. For older adults, it allows them to maintain independent living for longer, improve balance, and provides strength to be functional with ADLs (activities of daily living). 3. Sleep: Understanding healthy sleeping habits may prevent insomnia or changes in sleep-wake cycles experienced by many older adults as well as allow them to reduce the deleterious sleep aids often trialed.

Poor sleep quantity/quality is linked to the development of Alzheimer’s disease and other forms of dementia. 4. Stress management: The ability to cope and manage stress is a lifelong skill that allows people to return to their

“pre-event” status after an acute issue.

Maintaining a sense of purpose can be critical for older adults. 5. Avoiding risky substances: Alcohol can be especially dangerous in older adults as their metabolism changes. Older adults are more likely to fall, leading to devastating consequences, and suffer from unrecognized alcohol withdrawal upon losing access to drinks in acute scenarios, compounding lifethreatening situations. 6. Social connectedness: Older adults who stay connected with their community have increased longevity and better brain health. Social constructs facilitate the goals in all the above pillars.

Aging with LM promotes not only longevity but vitality alongside that longevity. We all know age alone means nothing, functional age means everything. Awareness and education are core to the LM mission. We have a unique opportunity to introduce LM during our care in the emergency department (ED). Challenge: The next time you are left with an unrevealing workup, spend a few minutes outlining the positive changes the patient might make in one of these six pillars to prevent a similar trip to the ED. It is possible that you could identify simple, feasible goals to move the patient to a healthier state. ABOUT THE AUTHORS

Dr. Harrison is dual board certified in emergency medicine and lifestyle medicine. After years in education as an assistant professor and assistant residency director at Yale School of Medicine, she now directs her passion for teaching toward educating her emergency medicine colleagues and local community about lifestyle medicine. Dr. Mulcare is fellowship trained in geriatric emergency medicine and clinical assistant professor of emergency medicine at Weill Cornell, New York. She has held several educational leadership roles at NYP/Weill Cornell. She is currently chief medical officer for Summus, the leading virtual specialty care platform.

About AGEM

The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”