Aging Gracefully -- David A. Lipschitz, MD -- 04/29/03
By David Lipschitz
Older Americans, and their unique healthcare needs, make up an increasingly large percentage of the U.S. population. If you're one of the growing numbers of seniors, read about making the later years the best years of your life. David A. Lipschitz, MD, author of Breaking the Rules of Aging, and host of the PBS series Aging Successfully with Lipschitz, was our guest.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Hello Dr. Lipschitz. Welcome to WebMD Live. What are these "rules of aging" we are supposed to break?
Lipschitz: Well, firstly, I think that many of us who are in the baby boomer generation recognize for the first time that we are not immortal. We're beginning to worry about old age and we are more and more concerned about the declining health of our parent. And we have all these negative stereotypes about aging. For example, my daughter recently called us slow, sick, senile, and sexless. I think many of us think that it's all going to be downhill from here. But I'm here to tell you that nothing could be further from the truth. Much of what we know about aging is just dead wrong. So here are some of the myths:
I have many more myths that I can talk about, but I think this may be an appropriate time to answer questions from the audience.
Member: I am getting forgetful. What can I do to keep my mind from slipping?
Lipschitz: An excellent question. Firstly, we do know that as we get older our mental prowess declines subtly. For example, we may not remember names as well; we may have greater difficulty with complex tasks. But this is no more than benign forgetfulness. On the other hand, by the age of 85, half the population has a problem with memory loss, that as I have said previously, is always due to an illness, the most common being Alzheimer's disease.
Now to specifically answer the question: We do know that you can do much at an early age to reduce your risk of Alzheimer's disease when you grow older. Here are some of the things you can do:
Other ways to protect your mind include perhaps taking vitamin E, a nonsteroidal anti-inflammatory drug such as Motrin, and for a woman, estrogens may also protect against memory loss. I hope that information is useful to the member.
Member: Delicate question -- my husband and I are both in our 60s, and though we are both still interested in sex we often find the end-of-the day fatigue really puts a damper on our fun. Any suggestions for perking up?
Lipschitz: Well, firstly we know that the single most important aspect of a good sex life is to be in love. Love and intimacy is the key. Perhaps this is the major reason why sex improves with age. When we're older we're less tense, we're less interrupted, we're less worried about pregnancy, and more of us are more willing to experiment. Remember the importance of intimacy and vulnerability.
Now to answer the specific question: Of course, being fatigued at the end of the day is a problem or all of us. So the answer may be to make the weekend a time for hanky-panky. Or, what about the early morning? The morning is a great time for sex. But remember, the best way to enjoy a sexual experience is to think about being in love, being romantic, being in an idyllic setting, and making time for your self. And finally, if at the end of the day you are so fatigued, you may think of changing your priorities somewhat.
Member: As a 41-year-old male I worry about losing my sexual ability as I get older. What is sex like for older men?
Lipschitz: Many men believe, erroneously, that sexual prowess goes down with age. Unfortunately for men, potency appears to be the essential element of their masculinity. In fact, as we grow older, it is more difficult for many men to develop and sustain an erection. This, in effect, has its advantages rather than disadvantages. Foreplay becomes more important; intimacy becomes more important; togetherness becomes more important. This is what most women want. So the experience becomes much more satisfying for both. So don't worry; sex will be great throughout your life. Remember that growing older does not affect the ability to have sex.
However, as we grow older, illnesses, medications, changes in hormone levels, particularly in women, make sexual dysfunction more common. In men, it's primarily erectile dysfunction and lack of libido. But women have sexual problems as well. These include loss of libido, an inability to be aroused, an inability to have an orgasm, loss of lubrication, and pain with intercourse. Fortunately, for both men and women, appropriate treatment and counseling can be of great benefit.
Member: I am turning 50 this year and have been pretty much a couch potato for most of my life. I am starting a new walking program and am trying to eat healthier. Is it possible to reverse the bad effects caused by my previous inactivity?
Lipschitz: Well, firstly the answer to your question is a positive and resounding yes. It's never too late for members or older members to begin an exercise program. In general, if you are 50 or beyond, it's probably a good idea to have a medical checkup before embarking on a new exercise program. After obtaining a clean bill of health, an appropriate exercise plan can be developed. Remember to set your expectations high. Start slow, but continuously strive to do more. Walking is an outstanding form of aerobic exercise. The absolute minimum for good health is to walk 10 miles a week as briskly as feasible -- the more the better. You may also consider varying an exercise routine, perhaps including bicycling, swimming, or aerobic classes to develop an appropriate routine.
Finally, think about joining a health club and exercising with weights. More people die of falls and fractures than from breast, colon, and prostate cancer combined. As we get older, we lose muscle strength and bone strength. By the mid-70s and beyond, weakness and frailty become common, and falls are almost epidemic. The best way to reduce falls with advancing age is to resistance train by using weights or machines, but please do it under supervision, and don't do it alone. Proper form is the key.
So in summary, a good exercise program includes both aerobic activity, increases your heart rate, and resistance training, which can increase strength three-fold, build bone, and reduce your risk of falling when you're older by 80% or more. Resistance training has the potential of saving billions of healthcare dollars.
Member: What is the impact of a lifetime of stress on one's later longevity? According to The Secrets of Aging Well, affective disorders, such as depression and social isolation tend to shorten the extent of one's potential longevity. If this is the case, then if one experiences long-term chronic stress during childhood, experiences later anxiety and depression during one's adult years, and then heals from this chronic stress response from short-term psychodynamic psychotherapy during middle age, how will this state of "mental wellness" impact on one's later longevity?
Lipschitz: Firstly, what we all want for ourselves is a long and independent life. The key elements of a long and independent life are first to be healthy and second to be happy. Stress, depression, and anxiety contribute to problems with happiness, and there is no question that chronic stress is a major cause of both illness and of an impaired ability to recover from an illness. We also know that attempts to modify and reduce stress are highly effective. For example, meditation and the ability to meditate well, is the most powerful factor in reducing risk of a heart attach for a person who has had one. Learning how to cope with stress, being treated by psychotherapy, in my view, is extremely beneficial. Healing from a stressful life through psychotherapy has the capacity to substantially prolong life, reduce risk, and most importantly, improve life's quality.
Member: Can you please comment on the influence of social connections on quality of life for older people? I'm concerned about my mother. She has outlived her friends and most importantly, has outlived my dad. They were together for 55 years. She no longer knows anyone her own age. She isn't completely isolated; the family is around her daily and she has formed a friendship with her physical therapist. But she knows no one her own age.
Lipschitz: Firstly, there is no question that social isolation is a tremendous problem for older persons. Your mother clearly has had a long and wonderful life, and has outlived many of her friends. The most important way of assuring the highest possible quality of life for your mother is to assure that she is surrounded by loved ones and has contact with as many family members and others as possible. Your mother is extremely fortunate that she has a devoted family who spend time with her.
A serious problem that we see frequently is socially isolated older people who refuse to leave their homes, rarely see anyone and who frequently become depressed, develop serious medical problems, and are often malnourished. A major role of a geriatric program is to identify this problem and to work closely with the family and others to persuade the person to change their environment. Ideally, a parent should move in with a child. This does occur on occasion, but is often not feasible. Assisted living programs are an alternative option. Being around people "your own age" socializing and becoming engaged in day-to-day life will not only improve life's quality but also reduce risks of dependency and illness.
Member: Is there a correlation between theists and atheists (or agnostics) relating to longevity?
Lipschitz: The answer is yes. People who have faith live longer and are less likely to develop illness than those who do not. People who believe in a higher power are much more likely to handle stress than those who do not. There has been a great deal of study on the role of spirituality in health. Belonging to a religious community provides access to an immediate support group in times of need. Prayer tends to focus on love and forgiveness, rather than getting even and hate, and this appears to be beneficial. Prayer appears to have positive benefits on psychological function, similar to any form of meditation.
However, pantheists, who believe that God surrounds us in everything and who are very spiritual but who do not belong to an organized religion, have similar benefits. We do know that it's not going to religious services that's important, but rather being spiritual. And the element of spirituality that correlates most closely with longevity and health is the ability to forgive, to no bear grudges, to let go, and to hear both sides of any argument.
Member: The older I get, the more inflexible my joints become. How can I keep my joints and muscles in shape so that I can enjoy the activities I have always loved?
Lipschitz: Well, the single most common chronic disease is osteoarthritis. It is almost universal that by the age of 60 and beyond, we will have some joint or back pain. The mechanism is related to injury at a young age, to loss of muscle strength as we grow older that changes the mechanics of the joints and results in the joint surfaces rubbing against each other, alterations in the joint ligaments with age, and of course problems with posture. So most of us will experience joint pain. In some it's much worse than others.
The treatment for osteoarthritis is as follows:
It is very important that joint pain not be ignored. Discuss it with your physician, see an expert if necessary, and be sure an appropriate plan is developed for you.
Member: I have a sister I'm taking care of; her age is 91. And I'm worried about her diet. Her breakfast consists of grits and butter, oatmeal, and sometimes I would cook an egg and cheese in her grits. She will not eat much meat, maybe once or twice a week. She always wants mashed potatoes or macaroni and cheese. She looks like she is losing weight. She does take vitamins every day. She also drinks milk and has a glass of juice four times a week. I'm worried about her getting enough proteins. What can I do to stop her from continuing to lose weight? What type of food should she eat? She does not have any teeth. And I can't afford to buy her any. I do grind up the little meat I give her. Help! Her medications are: Celebrex, cyproheptodine, Centrum performance vitamins, propoxy-n/apap. What can I do to keep her healthy and stop her from getting smaller?
Lipschitz: Weight loss is a far more serious problem in the age over 75 than weight gain. In fact, after that age the chubbier you are the longer you live. Any weight loss, even voluntary weight loss, is often associated with an increased risk of illness and even death.
Our goal, when we see a person who is eating inadequately and losing weight, it to first try and identify a cause. Your sister is taking numerous medications, has no teeth, and may have a number of chronic conditions that suppress appetites. The first approach is to have her evaluated by a competent physician to attempt to identify problems that could affect her appetite. Often medications prescribed for other conditions suppress appetite and lead to weight loss. Making sure that her medical condition is optimum is very important.
Just as important is an evaluation by a dietitian and recommendation for a meal plan that is best for your sister. This might involve the use of high protein nutritional supplements, such as Ensure Plus and others that are readily available. Obviously, the lack of teeth is an important consideration in your sister.
Finally, we know that as a person approaches the end of their life, a condition develops that we call "failure to thrive." Here weight loss occurs, appetite decreases, and the person gradually fades away. Unfortunately, little intervention on our part is able to reverse this end-of-life process. It's important that the family understands what happens and does not feel guilty that their loved one now has no desire to eat and appears to be fading away. This really reflects death from "old age" is as natural and important as any other aspect of life. It's important we understand the value of maintaining an older person's dignity and of not trying to be too aggressive in attempting to reverse a natural process.
Member: I am concerned about the number of medications my husband is taking. It seems like he just keeps getting more and more prescriptions. It can get confusing to keep them sorted out. How can we manage all of these medicines? Also, he is 64 and when he retires next year, I'm worried that Medicare won't cover them anyway.
Lipschitz: One of the single biggest problems facing older persons is a condition called poly-pharmacy. Patients see multiple physicians, the left hand does not know what the right hand is doing, and too many medications are prescribed. After taking six medications the risk of side effects increase astronomically. Approximately 30% of all hospitalizations are due to side effects of treatments.
One of the most satisfying aspects of being a geriatric physician is being able to manage poly-pharmacy. The best advice I can give you is to have only one physician who becomes responsible for all medications. Preferably, attend a senior health center and be seen by a geriatric team, which includes a physician, nurse, social worker, and most importantly, a pharmacist. Often we can cut the number of medications prescribed by 50% or more. The benefits can be astounding. The problem is compounded by the fact that many individuals who are over the age of 65 are in a list to "never prescribe to someone over the age of 65."
WebMD is a great source to study and learn about what medications to avoid when you're older. It is very important that everybody be an educated consumer of healthcare, that we understand our illnesses and we have the capacity to ask the right questions. One of my key tenets is never believe everything your physician tells you. Question him or her and make sure that what is being done for you is both appropriate and not risky.
Moderator: Dr. David, what are the top five tips you can recommend to anyone who wants to age successfully -- active, happy and well?
Lipschitz: The goal is to have a long and independent life. My five top tips are as follows:
Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Our thanks to David Lipschitz, MD, and thank you members for joining us today. For more information, please read, Breaking the Rules of Aging by David A. Lipschitz, MD.
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