Transcript Physiology of Aging

Resilient Aging
Gregg Warshaw, MD
University of Cincinnati
OAGE Conference
Dayton, Ohio
March 28, 2014
Myth #1
To Be Old is to Be Sick
Self-rated Health
Percentage
ADL/ IADL Limitations
National Health Interview Survey, 1999 data. CDC. NCHS.
Myth # 2
You Can’t Teach an Old Dog
New Tricks
Myth # 3
The Horse is Out of the Barn
Myth # 4
The Secret to Successful
Aging is to Choose Your
Parents Wisely
Myth # 5
The Lights May Be On but the
Voltage is Low
Myth # 6
The Elderly Don’t Pull Their
Own Weight
What is Aging?
Aging
Is not a disease
Occurs at different rates
• among individuals
• within individuals
Does not generally cause decline in
function or significant symptoms
Usual Aging
Functioning well
AT RISK for disease and disability
MOST older adults
Usual Aging: RISKS
Decline in reserves in organ systems
Decline in immune/recuperative
power
Successful Aging. . .
If we can figure out how to get the Baby
Boomers to arrive at old age in better shape:
• Society’s health care costs will be reduced
• Life-long personal resources will be saved
• Families will be less burdened
Rowe & Kahn (1987)’s
definition:
• Few or no age-related declines
• Implies that it is possible to reach advanced age
•
relatively free of age-associated disease and
functionally intact
Paradigm shift, but number of persons
experiencing this type of “successful” aging is
minority
Successful Aging vs.
Resilient Aging
Alternate definitions
• “Minimal interruption of usual function”
• “Doing the best with what one has”
Shifts the focus from minority to majority
• Major differentiator:
extent to which a person can
have a chronic disease or functional disability and
still be considered to be aging successfully
Resilient Aging
Avoid or manage chronic illness and disability
Engage independently or with support in most
normal activities of daily living
Maintain cognitive function
Able to cope with physical, social, and emotional
changes
Sense of control of life
Determinants of Successful Aging
Biologic
Aging
Disease
Health
Behaviors
Social
Supports
Normal Physiologic Effects of Aging
Copyright © 2010 Pearson Education, Inc.
Determinants of Successful Aging
Biologic
Aging
Disease
Health
Behaviors
Social
Supports
Determinants of Successful Aging
Biologic
Aging
Disease
Health
Behaviors
Social
Supports
Lifestyle Choices
Diet
Exercise
Smoking
Drinking
Rather than seeking permission
to exercise, you should have to
get permission to be sedentary.
Maria Fiatarone, M.D.
Source Undetermined
Source Undetermined
Benefits of Exercise
 Weight loss
• Decrease central adiposity
• Increase lean body mass
 Blood pressure decline
 Aerobic capacity increase
 Insulin sensitivity increase
 Increase bone mass
 Increase muscle strength
 Increase perceived well being
Determinants of Successful Aging
Biologic
Aging
Disease
Health
Behaviors
Social
Supports
Social Factors
Marriage
Family
Friends
Religiosity
Work
Volunteering
Centenarian Characteristics
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Resiliency
Independently functioning
In good health at least to
the age of ninety.
Few centenarians are
obese
Substantial smoking history
is rare
Source: Perls T., Silver M., Lauerman J, 1998
Health Promotion Needs to be a Major Focus
for Geriatrics/Gerontology Professionals
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Regular exercise
Healthy diet
Avoid tobacco
Alcohol in moderation
Correct use of medications
Screen for disease and treat early
Education about caring for illnesses
Strengthen social network
Reasons for Geriatrics/Gerontology Professionals to
Focus on Health Promotion/Disease Prevention
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Prevention of premature death
Delay of the onset of chronic diseases
Postponement of disability related to chronic diseases
Higher quality of life
Greater participation in the life of the family and
community
Reduction in medical care costs, especially
hospitalization and nursing home costs
To Summarize…
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Longevity is a splendid trend in the United States
Successful, resilient aging is complex
Exercise, Exercise, Exercise
Achievements of centenarians demonstrate that
physiologic aging can allow for late life
independence, productivity, and pleasure
“Age is not a particularly interesting subject.
Anyone can get old.
All you have to do is live long enough.”
—Groucho Marx (1890-1977)