Women and Healthy Aging

Dean Sherzai MD, MAS, PhD(c)

Director of Loma Linda Memory and Aging Center

Director of Loma Linda University Neurology Research Program

Population Pyramids

2000 2050

Toshiko Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingand Health.aspx, Source: World Population Prospects: The 2004 Revision (2005).

• The number of older adults is expected to double within the next 25 years

• By 2030 about 1 in 5 Americans (72 million people) will be >65

• The age group >85 is now the fastest growing age population

• 1/3 of older people live alone; 2/3 live with or near family

Demographics

• Few live in skilled nursing facilities (15% of those >85)

• 70% of total net worth in U.S.• 85+ population with Alzheimer’s

Disease is close to 50% and is growing

• Aging (Baby) Boomers have been turning 65 this year

Demographics

CENTENARIANS

1900 – RARE1982 – 32,0001998 – 61,000

2050 – 600,000

SUPER-CENTENARIANS

Active AgingPicasso > 90T. Vecellio (Titian) > 90Michelangelo sculpted at 89Verdi wrote “Falstaff” at 84Galileo > 75Linus Pauling > 80 Martha Graham danced till 75 and

choreographed at 95Artur Rubinstein’s last recital at 93

and many other....

Gladys "Glady" Burrill, 92

9

Overview

• Aging and Health• Chronic Disease in Later Life• Health Promotion

~ Lifestyle changes~Screening and prevention

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Causes of Death for People >65

National Vital Statistics Report, 2002:• Heart Disease – 32.4%• Cancer – 21.7%• Stroke – 8.0%• Chronic lower respiratory disease – 5.9%• Influenza and pneumonia – 3.1%• Diabetes – 3.0%• Alzheimer’s disease – 3.0%• Other – 22.08%

Chronic Diseases

• The most prevalent chronic conditions in people >75 are much more common in women

• Racial and ethnic differences in health status continue with the leading causes of death and disability dramatically higher among racial and ethnically diverse populations

Key Strategies for Improving the Health of Older Women

• Healthy Lifestyle Behavior• Injury prevention• Clinical preventive services• Immunization and preventive

screenings• Management techniques for those

with chronic illnessesAdapted from Generations (2005)

Self-Efficacy

• Self-efficacy implies control and places one’s wellness in one’s own hands

• Often older people place the responsibility for their health in the hands of physicians and nurses

• We need to change older people’s expectations of physicians, particularly in the area of health prevention and health maintenance

Aging and Health

The Aging Process

• Generally involves slowing down of systems

• Varies greatly among individuals• Influenced by genetics,

environment, lifestyle factors

Physical Changes of Aging

Heart

Muscles

Brain

Skin

Kidney

Vision

Hearing

Bones

Taste

~ Pumping effectiveness decreases~ Muscle mass decreases~ Some loss of cell structure and

function~ Dryness, slower healing~ Less efficient~ Decreases in depth perception,

color perception, and peripheral vision

~ Decreased acuity, esp. higher pitch~ Mineral loss faster than

replacement~ Decreased taste buds, saliva

production

Chronic Disease in Later Life

Definition

Chronic disease:

• Prolonged health condition• Can last for many years • Rarely cured completely• Care is aimed at managing

symptoms, preserving function, and minimizing further damage

Examples

• Diabetes• Heart Disease • Arthritis

• High blood

pressure

• Cancer• Low Vision• Depression• Kidney Disease• Dementia

Why is it Important?

• Chronic diseases are the most prevalent and disabling conditions facing the elderly

• Four of every five elders have at least one chronic disease

• Chronic disease can dramatically reduce quality of life

• Chronic diseases account for over 75% of U.S. medical care costs (CDC, 2005)

Consequences/Impact

• Loss of function• Loss of mobility• Loss of

independence

• Disability• Pain• Death

Risk Profiles Combination of Causes

• Aging• Lifestyle• Environment• Heredity• Stress • Unknown

Health Promotion

Definition

• Increasing awareness of health issues• Promoting healthier behaviors• Creating supportive environments• Developing preventive strategies• Encouraging early detection and

treatment

(Am J Health Promot. 1989;3:3–5)

Why is it important?

Improve quantity and quality of life

• Reduce risk of developing chronic conditions

• Reduce the damage or limitations that result from an already existing chronic condition

• It’s never too early and it’s never too late to start healthy habits

What can we do to promote health?

• Stop smoking• Get active• Eat a healthy diet• See a doctor regularly• Get immunized• Get screened

See Your Doctor Regularly

See Your Doctor Regularly

• Early detection usually means a better outcome and less invasive treatment

• Regular check-ups should include dental, vision and hearing checks

• Get recommended screening tests done

• Get recommended immunizations

General Screening Recommendations

*check with your doctor for specific recommendations• Pap test – every 1-3 years up to age 65

• Lipid Screen – every 5 years, starting mid-thirties (male) or mid-forties (female) up to age 70

• Mammogram – every 1-2 years, age 40-74, then optional

• Fecal Occult Blood – every year, age 50-80+

• Lower GI Endoscopy – depending on individual factors, every 5-10 years, starting at age 50

• PSA – optionally, every year up to age 70 (men)

• Bone density – mid-sixties

Immunization Recommendationsfor older adults

• Influenza – every year age 65-80 (optional age 50-64)

• Pneumonia – once at age 65

• Td/Tdap – every 10 years

• Zoster (Shingles) – once at age 60

Health Promotion

• What unhealthy habits are common in your community?

• Is there an increasing awareness of healthy lifestyle changes?

• What barriers to better health habits exist in your community?

• What are some nutritional issues affecting older people in your community?

• What resources are available in your community to help seniors get adequate nutrition?

The best thing to do to feel better is to get regular exercise

Get Active

• Lack of activity and poor diet are second only to smoking in contributing to cause of premature death

• A sedentary lifestyle contributes to many chronic diseases including:

Heart disease, Cancer, Hypertension, Obesity, Lipid Abnormalities, Diabetes, Depression, Osteoporosis

Benefits of Physical Activity

• Increased energy

• Increased muscle strength and flexibility

• Better insulin response

• Improved mood

• Increased cardiovascular fitness

• Increased bone mass

• Better immune function

• Increased independence

(National Institute on Aging, 2004)

What Can I Do to Be More Active?

• Work toward 30 minutes of aerobic activity most days of the week

• Do things that use your muscles

• Do things that make you use your balance

• Stretch to maintain flexibility

• Do things you enjoy or try something new:walk, bike, garden, yoga, tai chi, dance

• Mix it up!Always talk to your doctor before starting an exercise

program

Eat a Healthy Diet

Why is it Important?

• It has been estimated that 10 to 25 percent of elderly people suffer from poor nutrition

• Poor nutrition can contribute to:

•Heart disease•Cancer•Diabetes•Depression•Difficulty thinking

•Anemia•Frailty•Obesity•Osteoporosis•Isolation

Quick Tips for Healthier Eating

• Eat more fruits and vegetables

• Eat whole grains, nuts, beans

• Choose foods low in saturated fat, trans fat, and cholesterol

• Get enough calcium

• Get enough protein from low fat sources

• Cook with less fat

• Minimize foods high in sugar

• Drink enough water

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CalciumAs women get older their bones lose calcium

and get weaker and more breakable

Its very important for women to eat lots of calcium-rich food like milk, yogurt, broccoli, oranges and leafy

greensHeartland Alliance Refugee Health Programs

The Aging Brain

The Aging Brain

• Loss of volume • Memory

retrieval• Processing

speed• Multi-tasking • Memory

formation efficiency

•Verbal IQ•Vocabulary•Store of information•Comprehension

ChangeNo Change

Brain Changes With Aging

• Brain weight:

• Decreases by about 0.5% per year after age 30!

• Neuron loss:

• Region-specific

• 10-25% loss in cerebellum, cortex, hippocampus, substantia nigra, Frontal Lobe

• Loss of synapses (connections between neurons)

• Mild degree of Alzheimer-type pathology

Causes of Memory Changes in Aging

• Normal aging *

• Neurodegenerative diseases / Alzheimer’s disease

• Medications

• Alcohol

• Depression

• Anxiety

• Head trauma

Alzheimer’s disease

Mild CognitiveImpairment

Normal AgingNormal Aging

No change over time

Other dementias

• Variable definition• Originally defined as a memory only

syndrome• Defined loosely -include memory and

cognitive problems, yet normal ability to do ADLs

• Conversion to AD at a rate of about 10-15%/year

• Normal elderly – 1-2% per year• The non- memory types are those at risk

for other types of dementia

Mild Cognitive Impairment

What is Dementia?Loss of memory and

other intellectual abilities serious enough to interfere with daily life

Alzheimer’s is most common form of dementia, but there are many other reasons........

Degenerative Diseases

• Alzheimer’s disease (>60%)• Lewy Body Disease (20%)• FTLD (2-5%)• Parkinson’s disease and Dementia

(PDD)• Huntington’s • PSP• Some others: CBGD, Kearns-Sayre,

Hallervorden-Spatz, Wilson’s disease, etc.

AD Statistics….

• Most common cause of dementia among people age 65 and older.

• 5.3 million people now have AD.

• 1 out of 8 over 65; 1 out of 2 over 85

• For every 5-year age group beyond 65, the percentage of people with AD doubles.

What is AD?

• By 2050, 13.2 million older Americans are expected to have AD if the current numbers hold and no preventive treatments become available.

Brain Mass Change

• ? Protective ? Protective factorsfactors

• NSAID useNSAID use• Estrogen useEstrogen use• StatinsStatins• Anti-oxidantsAnti-oxidants• ExerciseExercise• DietDiet• Mental activityMental activity• Psychosocial Psychosocial

factorsfactors

Risk factors for AD• Major Risks• Age • Family

history• Genes (Apo E

4, others)

• Minor Risks• Head trauma• Low

education• Female sex

• Major Risks• Age • Family

history• Genes (Apo E

4, others)

• Minor Risks• Head trauma• Low

education• Female sex

Warning Signs

• Memory changes that disrupt daily life

• Challenges in planning or solving problems

• Difficult completing familiar tasks• Confusion with time or place• Trouble understanding visual

images and spatial relationships

Warning Signs (cont.)

• New problems with words• Misplacing things and losing

ability to retrace steps• Decreased or poor judgement• Withdrawal from work or social

activities• Changes in mood and personality

Scientists examine characteristics, lifestyles, and disease rates of groups of people to gather clues about possible causes of AD. The NIA is currently funding epidemiologic studies in a variety of different groups. Two of the studies focus on religious communities. Researchers conduct yearly exams of physical and mental status, and studies of donated brains at autopsy. Some early results indicate:

• Mentally stimulating activity protects the brain in some ways.

• In early life, higher skills in grammar and density of ideas are associated with protection against AD in late life.

Epidemiologic Studies

AD Research: the Search for Causes

Why early diagnosis & follow-up is important• Major cause for mortality and

morbidity is late treatment of behavioral disorder• Early identification means • Behavioral and environmental measures

work• Can start with milder drugs• Can control the progression and treatment• Not forced into high doses of strong

medications• Not forced into early irreversible decisions

Research at Loma Linda University

• Molecular, Genetic, Pharmaceutical research in aging

• Looking at influences of Lifestyle and prevention on aging outcomes

• Community based approach to aging research and aging support

MEMORY and AGING CENTER

LOMA LINDA UNIVERSITY

Faculty Medical Offices

11370 Anderson St. Suite 2400

Appointments: 909-558-2880Messages: 909-558-2233Fax: 909-558-2237

Thank you!

Questions?