Optimal Aging

All of us would like to age well. It has been suggested that aging successfully means the absence of disease and disability, good mental and physical function, and active engagement with life. Does this mean persons who are battling a disease or who have a disability have aged unsuccessfully? I prefer to embrace the concept of “optimal aging,” which takes into account psychosocial factors such as the ability to cope and deal with adversity, adaptability, good self-esteem, positive attitude, and self-efficacy.

For many of us, aging will bring with it things we don’t like—maybe arthritis, Parkinson’s disease, or heart problems. Aging optimally entails optimizing physical function as much as possible, but also embracing the other dimensions of wellness—emotional, social, intellectual, spiritual, and purposeful. Today I welcome your questions related to optimal aging.

Q: Andy, IL – What is the number one thing I can do to age well?

A: Dr. O’Neil - Although there are several things I suggest to age well, Andy, I would say that the single most important thing is to stay socially engaged. Although we know that regular physical activity brings profound benefits, it has been demonstrated that social interaction can lower all-cause mortality as much as fitness activities. Naturally good nutrition and physical fitness activities are important, but the love of family and friends and continued social engagement are essential to optimal aging.

Q: Susie, ID – How old is too old to start an exercise program?

A: Dr. O’Neil - You are NEVER too old. A key message is that the benefits of regular fitness activities can be realized in just a matter of a few weeks. It does not matter how old you are and it does not matter what shape you are in right now. There a very few medical contraindications to fitness activities. However, some folks will need an individually tailored program if they have arthritis, a rotator cuff tear, Parkinson’s disease, etc. This is where an exercise instructor, a physical trainer, or physical therapist can guide you. It may be necessary to start slowly and gradually build up. Check with your doctor to make sure it is OK to start.

Q: Uma, IL – How do you define Optimal Aging?

A: Dr. O’Neil - I like the definition proposed by Dr. Kenneth Brummel-Smith at Florida State University Medical School: Optimal aging is the capacity to function across many domains—physical, functional, cognitive, emotional, social, and spiritual—to one’s satisfaction and in spite of one’s medical conditions. This definition recognizes that many people can age quite well in spite of disabilities or adverse medical conditions. Attitude and resilience play a big role.

Q: Mary, CA – Can you share any research from Optimum Life regarding the benefits of socialization and nutrition? How can those benefits be achieved for those who live at alone at home?

A: Dr. O’Neil - Mary, social engagement is one of the single most important factors to aging well. If you are living alone it takes extra effort to be sure you are active in your community and with your family. Look for senior centers and volunteer opportunities as well as creative endeavors in your community. There are many ways to get involved in most communities. Nutrition requirements do not change with age but caloric requirements decline so nutrient dense foods are very important.

Q: Holly, WI – What do you recommend to keep my brain sharp?

A: Dr. O’Neil - A key thing to remember is what is good for your heart is good for your brain; what is bad for your heart is bad for your brain. With that in mind, I suggest that you consume a Mediterranean diet, one that is rich in whole grains, fruits, vegetables, and fish—preferably cold water fish such as salmon, mackerel, sardines, lake trout, and herring since they are rich in omega-3 fats.

A handful of mixed nuts (unsalted) is a good idea. Red meat should be limited. Alcohol should be consumed in moderation—I do not suggest that you drink if you do not do so already. You should engage in a regular physical activity program. Ask your doctor for guidance on what is right for you. Stay intellectual stimulated and socially.

Q: Janice, CT – Does red meat consumption affect the aging process?

A: Dr. O’Neil - Red meat is a good source of protein and other nutrients. However, it does contain saturated fats that are not good for the body in large amounts and can lead to heart disease and other problems. Most experts suggest that red meat consumption be limited to twice per week. When eating red meat choose lean cuts such as filet or 90% lean ground beef and stay away from the highly marbled cuts.

Q: Dorothy, WI – Dr. Kevin, What is the average life span for a woman in the US, what about other countries-how do we compare?

A: Dr. O’Neil - Life expectancy for a woman in the US is currently 78.1 years. We are 50th on the list compared with other countries. However, if you have lived to be 65 chances are that you will outlive this number by a few years. Interestingly, the fastest growing segment in society is the age group over age 85.

Q: Uma, IL – Why does the aging population have anemia?

A: Anemia or low blood count is common in older persons but is not normal. It requires a thorough evaluation as anemia may be a manifestation of nutritional deficiency, kidney or liver disease, and even cancer.

Q: Uma, IL-How do you suggest we stay emotionally stable during the challenges of old age?

A: Dr. O’Neil - Sometimes life can deliver some unexpected and painful surprises. In addition, we may have to deal with some things that are very challenging emotionally such as the death of a spouse, a chronic disease, etc. Maintaining a strong personal identity is important—finding something that gives us and our lives meaning is essential. For example, research has shown that those who have a strong personal identity, who have some of their own interests and friends with whom they regularly engage, do better following the death of a spouse than those who don’t. Bereavement still occurs, but chronic and major depression may be avoided.

Other things that help: positive attitude, a good sense of humor, and staying connected with our spiritual side.

Q: Tim, IL – With the healthcare industry in a state of possible transition and the medical community needing to watch every dollar for service what do you suggest the average person do to make sure they are getting the best possible treatment? It can appear that it’s easier to prescribe a pill then to take the extra few minutes to really find the root of the problem. What are you thoughts on alternative medicine integrated with traditional medicine?

A: Dr. O’Neil - My suggestion is to do some research before establishing with a physician. Find someone you can feel comfortable talking to and who is receptive to your questions. Your doctor should be an advocate for you and should be able to help you discern medical and complementary therapies that are based on good research evidence. There are many things being promoted to the public to promote wellness that are not based on good evidence and may in fact be harmful. Recently an editorial was published in The New England Journal of Medicine called “American Roulette.”

This article brought to light the serious problems that can occur with some herbal and over-the-counter supplements when they are taken without supervision. Many can interact with prescription medicines or have adverse effects on other medical conditions. So a doctor’s guidance is important. Hopefully, health reform will bring some restructuring of the system to promote and encourage preventive health practices and wellness programs.

Q: Brenda, FL – Do spiritual practices make a difference in health aging?

A: Dr. O’Neil - Most studies have shown a positive effect of spirituality on health. Finding something that gives us a sense of hope, comfort, and meaning can reduce stress and give a sense of purpose that translates into positive health outcomes. Spiritual practices can also suppress the “me” or ego center in the brain, so that we focus less on our own problems and more on helping others. This can have very positive benefits emotionally as well as physically.

Q: Jean, IL – How is dental health related to overall health?

A: Dr. O’Neil - Dental health is extremely important as we age. It is especially important to floss your teeth on a daily basis. Belief it or not flossing has been shown to add 7 years to the life span. The reason for this is unclear but may have something to do with having low levels of bacteria in the mouth that can lead to inflammation.

Click here for more dental health information and tips.

Q: Anna, IL – How much sleep does the average person need for optimal aging?

A: Dr. O’Neil - Anna, most people need about 7-8 hours of sleep per night although individual requirements vary. The body repairs itself during sleep so it is very important to get enough sleep to keep the body healthy. If you are having trouble sleeping (and many older adults do) talk to your health care practitioner about some measures you can take to help you improve your sleep patterns.

Click here for more information on the health benefits of a good nights sleep.

Q: Anna, IL – Is there an optimal level of socialization that you recommend? Is there a minimum amount?

A: Dr. O’Neil - Anna, everyone is different in terms of how much social contact they need. On average about three social engagements per week is a good number to shoot for. Quality of relationships is just as if not more important than quantity. Having someone with whom we can share our concerns and be intimate is important and this may be just one or two people in your life.

Q: Uma, IL – How do we take better care of our feet in old age?

A: Dr. O’Neil - If someone has a condition that inhibits circulation to the feet such as diabetes or vascular insufficiency good foot care is essential as a wound on the foot under these circumstances can be very difficult to heal. As we get older the fat pad on the bottom or the foot can wear away and cause more pain with walking. Look for shoes that are made well, offer good support and have good padding in them and look into wearing padded socks for extra protection.

Many older adults find it difficult to care for their toe nails as they get older and should see a podiatrist on a regular basis.

Q: Bill, TX – I heard that stress can cause heart problems. Is it true that it can increase the risk of Alzheimer’s disease?

A: Dr. O’Neil - We all go through some emotional stress now and then. Some stress can actually be healthy. A muscle that is stressed can make it stronger. However, chronic unrelenting stress can actually damage the muscle. The same holds true for emotional stress. Chronic emotional stress and depression are recognized as risk factors for heart disease. Depression is an independent risk factor for stroke. The risk for dementia is increased as well. The stress hormone cortisol is toxic to brain cells in the area that harbors memory.

So do everything you can to keep stress and depression at bay…exercise regularly, have a positive attitude and good sense of humor, stay connected with friends and loved ones, get in touch with your spiritual side, and find something that gives you a sense of meaning and purpose.

Dr. O’Neil - I enjoyed this month’s discussion with you on optimal aging very much. If I could think of one word that would describe what it takes to age optimally, it would likely be “resilience.” Life is going to throw us many curve balls. How we handle them will determine in a large part how successfully we can move on in a healthy and fulfilling way. A quote from Jack Penn that I think says this quite well is:

“One of the secrets of life is to make stepping-stones out of stumbling blocks.”

Next month we will discuss Parkinson’s disease and other movement disorders.

Best wishes for an Optimum Life!

Dr. Kevin