Health & Wellness

Aging Well: Joy . . . or Pain?
By Suz Redfearn, Special to The Washington Post, August 2, 2005

To Some Extent, How You Feel for the Rest of Your Life Is Under Your Control. Here's What Science Shows Can Boost Your Chances of Living Healthier, Happier and Longer.

We all crave that mythic pill that eradicates wrinkles, diminishes our risk of heart attack and averts dementia while ensuring that we live to be 99. A hale, attractive, cheerful 99, that is.

Don't bet your life on it.

Despite the constant promotion of products claimed to extend life and prolong vigor, nothing you can buy in a box, bottle or tube has been shown to extend anything other than your credit card balance.

"There are clearly no pills or potions that have yet been established to increase longevity, and in fact for many of such pills and potions out there, there are real concerns about adverse effects," said Richard Hodes, director of the National Institute on Aging (NIA).

You know the products he's talking about: human growth hormone, testosterone, antioxidants and dietary supplements with several hyphens in the name that (it's okay to admit it) you've begun to consider trying as the signs of aging multiply.

"People spend a lot of money on one kind of anti-aging remedy or another, and they have for thousands of years," said Peter Whitehouse, Case Western Reserve University professor of neurology and biomedical ethics, who studies age-related cognitive decline.

Alas, aging is still the fundamental fact of the life cycle, and the human mortality rate remains 100 percent. But we can, if we're fortunate, exercise some control over the timing of our death and what our life is like until that day comes. Hodes says studies have shown that about 25 percent of how we age is determined by genetics; the other 75 percent, by the environment.

Which is to say, by tending to our environment and what we do within it, we can shift the odds of a longer and better life in our favor, at least a bit. Of course, the best life practices won't prevent that proverbial bus from running you down this afternoon, or some cruel cancer appearing on your liver in September. But if those things don't intrude, there are a few key lifestyle choices you can make that science has connected with long and healthy tenure on this earth. And they are fairly well established to reduce risk substantially for early onset of the diseases most likely to kill or disable you: heart disease, stroke, diabetes, dementia and some cancers.

James J. Fries, professor of medicine at Stanford University School of Medicine, offers his "compression of morbidity" theory.

"By postponing the age at which chronic infirmity begins," he wrote this year in an issue paper from the Alliance for Health and the Future, "disability and morbidity could be compressed into a shorter period of the average human life span."

When he first proposed the idea in 1980, he wrote, "I predicted a society in which the majority of people could enjoy a long and vigorous life, with a relatively brief terminal collapse at the end." In other words, instead of suffering progressive heart disease, physical disability and dementia for the 20 years before your death, you can remain mostly healthy and vigorous until, say, 83 and die of whatever disease finally gets you at 84 or 85.

His theory is holding up, he says: Since 1982, disability rates in the United States have dropped 2 percent per year -- twice as fast as death rates -- thanks to better screening, diagnosis and preventive drugs, as well as to lifestyle shifts, especially the drop in the number of smokers. But rising levels of obesity have offset some of the gains and threaten to shift the numbers in the other direction.

How to further reduce disability and morbidity -- especially as they apply to you? Below are nine simple (if difficult) suggestions you can adopt, starting in the next half-hour, that science has linked to a longer, healthier life, or to a reduced risk for deadly disease. If you feel you've heard some of them before, don't blame us: Facts are stubborn things.

Exercise Daily

Reams of research suggest regular physical activity retards bodily decline, though the precise mechanism by which it might do that remains a mystery. Rigorous activity helps circulate blood throughout the body's tissues and organs, delivering nourishment and removing impurities. Exercise also helps maintain weight in a healthy range. Epidemiological studies associate a body mass index of 27 or greater (27.8 for men and 27.3 for women) with increased sickness and death.

Some good research connects aerobic capacity with living longer. A 2002 study in the New England Journal of Medicine looked at 6,213 men with and without coronary artery disease. It showed a 12 percent improvement in survival for every unit of metabolic capacity increased through endurance training.

In a 1999 study in the Journal of the American Medical Association (JAMA), low levels of fitness increased men's risk of death from cardiovascular disease by about five times; overall risk of death from all causes increased about three times. Experts also know muscle strength and balance can help protect against falls and related injuries that can compromise independence and, in the very old, lead to death.

‘More definitive data on fitness's protective benefits on life span is expected. NIA is developing a randomized trial to study how exercise affects people's risk for disabilities. This will be the first direct test of its kind to show "whether we can actually prevent decline in the living community," said Hodes.

Until that study's findings appear, make sure you get the Surgeon General's recommended 30 minutes of vigorous exercise daily. And read today's Lean Plate Club column for thoughts about incorporating strength training into your life.

Refine Your Fuel

Fifty years ago, 10 percent of Americans were obese. By 2000, 33 percent were. The increase, most of it in the last 10 years, translates into hundreds of thousands of deaths a year. Obesity is linked to type 2 diabetes, heart disease and 20 percent of all cancers.

The key to fighting obesity? Increase intake of fresh fruit, vegetables and whole grains, dump the junk foods and sugary sodas, watch your body mass index and cut portion sizes, say nutrition researchers. Of course, the most important factor in weight control is balancing calories in and calories out. (See "Exercise Daily," above.)

Additionally, studies associate diets high in fiber and low in saturated fat with longer, healthier lives. A recent UCLA study, presented July 13 at the International Research Conference on Food, Nutrition, and Cancer, showed that such diets also lower breast cancer risk and slow tumor cell growth. Last fall a study in JAMA offered strong support for the Mediterranean diet, based on grains, olive oil, vegetables, fruits and fish. The study followed more than 2,300 healthy men and women ages 70 to 90 for 10 years; those who combined such a diet with about 30 minutes of daily exercise, moderate drinking and not smoking were more than 50 percent less likely to die from any cause.

Can you go further? You've probably heard about promising research, in animals and to some early degree in humans, about benefits of severe caloric restriction -- say, cutting daily calories by about a third. Case Western Reserve's Whitehouse said the results on smaller caloric-restriction studies in humans have been stunning: Cholesterol levels, blood pressure and other major risk factors for heart disease plummeted, along with risk factors for diabetes. But this kind of diet is very hard to sustain, may compromise nutrition and isn't proven yet.

Supplementing some vitamins and minerals is also critical as you age and lose some of your ability to produce them or absorb them from foods, according to the National Academy of Sciences (NAS). Vitamin B-12 helps protect against anemia and neurological disorders; it's also been shown to lower levels of the amino acid homocysteine, associated with risk of heart disease, stroke, Alzheimer's disease, Parkinson's disease and osteoporosis. Calcium helps protect against osteoporosis, colorectal cancer and cardiovascular disease. It also helps lower blood pressure and cholesterol levels. Recent evidence suggests that Vitamin D, a preserver of bone health, may also help protect against breast, colon and prostate cancer.

Stay Connected

Don't isolate yourself -- now or when you're older. Research has shown that the more connected you are to a community -- be that your family, your synagogue or your book group -- the longer you are likely to live. That makes sense given our evolution from social pack animals whose survival depended on being part of a group, said Robert Butler, professor of geriatrics at Mt. Sinai School of Medicine in New York and president and CEO of the International Longevity Center.

"Results in these studies seem to be related to the importance of intimate, personal relationships, but there's more to it to that," he added. "When you're sick, having family or friends there to go and fetch your medicine is also important."

Heart disease is just one of the health risks that's reduced by spending more time with others. A 2004 study of 6,861 Swedish men and women in the journal Social Science and Medicine found that those who participated in the highest number of social activities reported fewer cases of coronary heart disease.

Having a spouse counts, too. A 2003 study of 7,524 women over age 64 in the journal Psychosomatic Medicine associated both being married and having an active social life with reduced risk of death.

Being with your flock also confers protective benefits. A 2004 study of older adults in the journal Health Psychology found that those who attended religious services more than once weekly had lower mortality and elevated levels of interleukin-6 -- a substance produced by the body that can improve response to infection and disease.

Make sure your buddies are in the mix, too. A recent Australian study, said Butler, showed that friends -- who are, after all, the people you choose to associate with voluntarily -- were even more important to interact with frequently than family.

Watch the Alcohol

If you drink a lot, you're reducing your odds for that longer and better life you so richly deserve. But in recent years, much research has demonstrated benefits, for many people, of drinking just a little bit.

A study in the New England Journal of Medicine earlier this year found that one drink per day (equivalent to a 12-ounce beer, five ounces of wine or 1.5 ounces of liquor) may decrease the risk of cognitive decline in women. In fact, among the participants, who were aged 70 to 81, moderate drinkers had better cognitive scores than nondrinkers.

These findings join others showing that consuming one drink every other day to two a day may lower risk of heart attack, stroke and peripheral arterial disease. Heart attack risk saw the greatest reduction -- 30 percent. Over all, moderate drinkers die later than do nondrinkers or heavy drinkers, and they develop less disability than the general population.

The mechanism for such protective effects is not clear. But scientists know that moderate alcohol intake reduces blood clotting and blood pressure while raising good HDL cholesterol, thus improving the overall cholesterol profile. However, the American Cancer Society recommends restricting alcohol or abstaining, noting that even moderate drinking may increase the risk of several cancers. For women, findings from some 50 studies suggest alcohol consumption is tied to a higher risk of breast cancer. One drink a day appears to increase risk by 10 percent.

Ditch the Butts

If, like 40 million Americans, you're still smoking despite all the warnings, our finger-wagging won't likely stop you. The following data won't either, but here they are anyway: Tobacco use is the largest cause of premature death in the United States and the largest cause of disability. Smoking causes 90 percent of lung cancer cases and much of the cancer of the mouth, throat and esophagus. It can also lead to sudden cardiac death, emphysema and chronic bronchitis, while increasing bone loss and osteoporosis. There's also impotence, vision loss, a bad cough, icky teeth and lousy breath.

For all the damage smoking does, the body bounces back fairly quickly once a smoker tosses the butts. According to the American Cancer Society, three months after quitting, lung function improves by 30 percent. Within a year, quitters lower their risk of heart disease by half. Within five years, risk of stroke drops to that of a lifelong nonsmoker. Within 15 years, risk of heart disease does the same.

"There are no health benefits to smoking," said David Reuben, chief of the division of geriatrics at the University of California, Los Angeles (UCLA). "The only benefits lie in quitting."

We know, we know: Quitting smoking is one of the toughest acts in the personal health business.
If you're ready to try again, or just considering it, you can find help at the "How to Quit" site of the Centers for Disease Control and Prevention (http://www.cdc.gov/tobacco/how2quit.htm), the "Guide for Quitting Smoking" of the American Cancer Society(http://www.cancer.org , click on "quitting smoking," then click on "kick the habit," then on "quitting smoking") or the National Cancer Institute's site (http://www.smokefree.gov).

Challenge Your Brain

Ever thought about volunteering at a local school? Finally learning to speak Portuguese? Plowing all the way through "Finnegan's Wake"? If living long and well is your goal, it may be time to act. A growing body of research suggests that keeping your brain engaged on challenging tasks appears to help stave off cognitive decline, dementia and Alzheimer's disease. All three of these can lead to premature death and a poor quality of life.

The NIA conducted a seminal study in this area, published in 2002 in JAMA. Researchers divided 2,800 healthy seniors into three groups: One practiced strategies for remembering lists of words and details in stories. The second worked on reasoning skills, detecting patterns in information and using them to solve problems. The third group tried to boost processing speed by practicing such tasks as looking up telephone numbers, reading directions on prescriptions and responding to traffic signals. Each group showed improved cognitive ability, compared with baseline, at the end of the 10-week training and again two years later. A control group that received no training experienced no such improvement.

‘But after you challenge your brain with, say, a word puzzle, it's important to go out and have fun. A 2003 New England Journal of Medicine study linked participation in leisure activities like playing musical instruments, dancing, reading and playing board games with a reduced risk of dementia among 75-year-olds. Researchers theorized that such activities stimulate pleasure-oriented neurotransmitters, forming new connections in the brain.

Likewise, a three-decade-long study published in 2003 in the Annals of Internal Medicine examined 678 Catholic nuns, ages 75 to 107. Researchers found that those who regularly engaged in games and crosswords were more likely to remain mentally alert until death. Nuns who performed more menial tasks, such as housekeeping or kitchen work, did not tend to live as long.

Resource:

More info on Healthy Brains

Work With Your Doctor

According to Bob Gleeson, medical director of Northwestern Mutual Life Insurance Co. and author of "What Healthy People Know and the 7 Things They Do to Stay Healthy and Live Long" (Classic Day Publishing, 2005), most of us are born with the genetic wherewithal to live to 85. The challenge, he says, is to prevent premature disease from taking us down before that.

Outside of living the healthiest life possible per the kind of steps outlined in this article, the best way to do that, he argues, is to know which diseases you may have a higher risk for, discuss those with your doctor and schedule the appropriate screening tests for them.

There is no magic list of screens (yet) precisely tailored to your age, family history, environment and lifestyle. You've got to develop that with your doctor. For instance, does osteoporosis, the bone-thinning disease, run in your family? Your doctor may order a bone-density test, which the U.S. Preventive Services Task Force recommends for women 60 and older who are at increased risk; he may ascertain that you're getting enough calcium and weight-bearing exercise. At increased risk for heart disease or stroke? You and your doctor may want to discuss complementing lifestyle measures such as diet and exercise with statins -- cholesterol-lowering drugs -- or anticoagulants.

Want to have a sense of your risks before you consult your doctor? Some online tools can help you guesstimate your risk for diseases including heart attack, cancer and diabetes. See, for example:

The National Heart, Lung, and Blood Institute's risk calculator, www.nhlbi.nih.gov (click on "10-year risk calculator").
The American Diabetes Association risk calculator, www.diabetes.org.
The Harvard Center for Cancer Prevention risk calculator, www.yourdiseaserisk.harvard.edu (includes risk calculator for cancer, diabetes, heart disease, osteoporosis and stroke).

De-Stress

There's a widespread notion that stress can age you. But until recently, no one's been able to prove that, or show why.

Then last year, researchers from the University of California, San Francisco, published research in the Proceedings of the National Academy of Sciences showing that chronic stress speeds the collapse of the ends of gene bundles inside cells, hastening the body's physical breakdown. Researchers measured the lengths of telomeres--the caps at the ends of chromosomes, the molecules that hold genes. In 39 women ages 20 to 50 who had been experiencing long-term stress tied to their care of a child with a serious chronic illness, researchers found shorter telomeres than in a control group of women whose children were healthy.

The takeaway? Say experts, try to manage the stress in your environment. And find better ways to manage your response to that stress through exercise, meditation and relaxation. Controlled studies have tied meditation to lower blood pressure. A study this spring in the American Journal of Cardiology that followed 202 people over several years found lower rates of death from cardiovascular disease and cancer in those who practiced meditation. Moderate and high-intensity exercise has also been found helpful in relieving stress.

And get enough sleep. Studies show that averaging less than seven to eight hours of sleep a night increases the level of the stress hormone cortisol and interferes with normal metabolism.

Be Happy

Some research suggests that happy people live longer. That may sound like good news, but if people could simply make themselves happy as easily as they can modify their diets and take 30-minute walks, well, therapists would be out of business, the self-help industry would collapse and Dr. Phil would just be another loud bald guy who should lose some weight.

Still, the data are compelling.

In one study in last year's Archives of General Psychiatry, researchers gauged the level of optimism and pessimism in 999 Dutch men and women aged 65 to 85, then followed them for nine years. The upshot? The optimists had one-quarter the risk of cardiac death compared with their more pessimistic counterparts. The higher their level of optimism, the more robust their protection. The study also showed that optimistic people had lower death from all causes over nine years.

Other research suggests optimism has a protective effect on the immune system and helps ward off depression.

All right, if you're the cheerful and optimistic type, you've once again lowered your risk of early death. But what if you're not naturally sunny? Martin Seligman is the preeminent researcher in this often-ignored niche of psychology, and his book "Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment" (Free Press, 2002) provides a how-to guide. According to Seligman, you can experience happiness by absorbing yourself in your job or a hobby and spending time serving others.

British economist Richard Layard, author of "Happiness: Lessons from a New Science" (Penguin Press, 2005), agrees: Becoming happy and optimistic, he says, is essentially taking control of your emotions instead of letting them control you.

"It's a matter of how you organize your attention," said Layard. "You focus on the good parts of yourself and you look forward instead of looking back."

And, presumably, have more "forward" to look at than you otherwise might.

Resources

The American Pain Foundation www.painfoundation.org
The Arthritis Foundation www.arthritis.org

Books for Further Reading

Crowley, Chris and Lodge, Henry S., M.D. Younger Next Year: Live Strong, Fit, and Sexy--Until You're 80 and Beyond. (Men's version) Workman Publishing, 2007. 330 pages.
Description: Both men and women can become functionally younger every year for the next five to ten years, then continue to live with newfound vitality and pleasure deep into our 80s and beyond. Recommended by Denver Mayor John Hickenlooper.
Click here to order
Crowley, Chris and Lodge, Henry S., M.D. Younger Next Year for Women: Live Strong, Fit, and Sexy--Until You're 80 and Beyond. Workman Publishing, 2007. 432 pages.
Description: Both men and women can become functionally younger every year for the next five to ten years, then continue to live with newfound vitality and pleasure deep into our 80s and beyond.
Click here to order.
Henderson, Margit , PhD. Optimistic Aging: from Midlife to the Good Life, an Action Plan. Resilient Publications, 2005. 156 pages.
This book provides a succinct and accessible overview of the research about aging well, and gives you a broad range of options to strengthen your physical, mental, emotional and social health. Written by wife of Active Minds co-founder, John Henderson.
Click here to order.

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