SHELLEY WOOD | at Re:Imagine, 1 November 2007
Your Health as You Age
Groucho Marx famously said that age was not an interesting subject. "Anyone can get old," he quipped. "All you have to do is live long enough."
But for baby-boomers the topic is hardly banal - as the Canadian population ages, people have more and more questions about what to expect as they grow older.
The trouble is separating the hope from the hype, the true from the false. For all that aging is universal and inevitable, the mythology surround age-related health changes is rife with misinformation and half-truths.
MYTH or MAXIM: "Everyone gets dementia as they age"
False You misplace your keys, forget the name of a favourite restaurant and the excuse is, you're having a "senior moment." The reality is, not all seniors are forgetful or discombobulated.
"Dementia" is actually a catch-all phrase for a group of brain diseases that affect everything from memory and reasoning, to judgment, language, and perception. "The stats vary depending on what study you read but roughly 10% of people over 65 and 40% of people over 80 have dementia and the incidence continues to rise with age," says Dr Arja Moreau who has worked in the Elder Service Program at Kelowna Mental Health for more than a decade.
Alzheimer's disease is the most common type of dementia: in 2007, an estimated 450,000 Canadians over 65 were believed to have Alzheimer's or a related disease, the vast majority of them women. This number is expected to rise by 2011. Brain function can also be altered by strokes or other forms of damage to the brain and surrounding vasculature. That said, many men and women enter their golden years and leave this world with perceptions and memories far richer and more detailed then those of their harried offspring.
"The bottom line is that most seniors to not suffer from dementia," Moreau says.
MYTH or MAXIM: All men will develop prostate cancer if they live long enough
True (probably) While disputed, most experts acknowledge that prostate cancer would likely develop in most if not all men, should they survive every other disease that humans normally succumb to. That hypothesis, for obvious reasons, is impossible to prove. The good news, however, is that prostate cancer, despite being the most common cancer among Canadian men, is also one of the slowest growing forms of cancer. The Canadian Cancer Society estimates that, in 2007, an estimated 22,300 men will be diagnosed with prostate cancer; however, a much smaller number--4300--will die of it.
While these numbers may seem grim, the overall risk of dying of prostate cancer is minimal: in fact, most men will die of other causes before they develop any symptoms of prostate cancer.
This slow pace has implications for prostate cancer screening. Many cancer societies, including Canada's, recommend that men over the age of fifty begin discussions with their doctors about the risk and benefits of screening, since screening is only warranted if it leads to changes in disease management.
MYTH or MAXIM: "It's never too late to quit"
True Smokers who have lasted into their 70's or 80's will often tell you that having survived so long, why kick the habit?
"Seniors and clinicians would argue about this one," Moreau admits. "Many people insist that the pleasure they get from smoking is greater than the risk."
Those risks, however, don't diminish with age, nor do the diseases they cause become any easier to bear. While smoking is most commonly associated with lung cancer, it is also conclusively linked to heart disease, leukemia, cataracts, pneumonia, and cancers of the cervix, kidney, pancreas, and stomach. In the words of the US Surgeon General: toxins from cigarettes: "go everywhere the blood flows."
But smoking also has subtler effects, particularly in the elderly. Loss of mobility and function is one of the most commonly cited causes of depression and sense of isolation among older adults, and smoking exacerbates respiratory problems, cardiovascular disease, and osteoporosis, which can lead to falls.
Moreau also points to the psychological benefits of quitting that don't discriminate by age. "From my experience, people who quit at any age have a great sense of achievement and feel better," she says.
MYTH or MAXIM: "Old people don't have sex"
False A Canadian survey in 2002 sponsored by the National Advisory Council entitled "Sex over Sixty" helped to breakdown some of the misconceptions about seniors and sex. According to a Health Canada synopsis, sexual activity declines with age, for a range of reasons, but sexual interest and ability remain "fairly constant."
According to the survey, one-quarter of people over sixty said they had not been sexually active in the previous year, but the majority said that sex was important to them. Likewise, a majority of people surveyed between 65 and 74 described themselves as "sexually active."
Older men and women, not surprisingly, say they have less stamina than in their youth, they take longer to become aroused, and longer to reach "satisfaction." But on the flip side, seniors also cite the rewards of being more aware of what brings them pleasure, and the fact that they are more comfortable discussing this. Older lovers also point to the advantages of lovemaking unfettered by fears about unwanted pregnancies.
MYTH or MAXIM: "Your heart just gives out"
False Heart disease remains the number one killer of Canadians, but that doesn't mean that a heart attack spells the beginning of the end. While some people have heart attacks without first experiencing any of the telltale warning signs or having known about their baseline risk for heart disease, the physiological changes that lead to heart attacks and strokes do indeed begin much earlier in life. Researchers now know that the hardening and thickening of the arteries begins in young adulthood--perhaps earlier given the soaring rates of childhood obesity, diabetes, and inactivity.
The implication is that the damage is done. And certainly for many men and women diagnosed with heart disease later in life, or who suffer a sudden heart attack or stroke, the notion of turning their eating habits and lifestyles around can seem insurmountable, even futile.
What few people realize, is that heart attack risk involves a complex constellation of factors that does not necessarily begin and end with clogged arteries. In fact, heart attack risk is typically calculated using a checklist of so-called risk factors, some of which are indeed reversible. The ones that aren't are things like family history, diabetes, and the clincher: older age. But others, given equal weight in the equation, are factors like body weight, smoking status, physical activity, blood pressure, and cholesterol-levels that respond dramatically to lifestyle changes, diet, regular exercise, and/or medication. Mounting evidence also points to less conventional elements like social support and mental health. Studies show that married couples, or people who have strong support from friends of families, tend to stay healthier after a heart attack. Depression, which can frequently set in following a heart attack, is now being targeted specifically by heart-smart programs to improve quality and duration of life after a heart attack.
Using a multipronged approach, people can achieve a level of cardiovascular fitness in old age that they never had earlier in life.
MYTH or MAXIM: "Me and my medication are fine"
False Men, even more than women, are reluctant to take their prescribed medication and even less likely to tell their doctors that they've stopped taking something due to side-effects or a personal decision that a drug is no longer needed. Surveys suggest that 40% of seniors admit not following "doctor's orders": they either do not fill their prescriptions, or they don't take the drugs as prescribed.
"I always encourage seniors to ask their family physicians and pharmacists to review their medications. We metabolize medications differently as we age and the indication for, and the dose of medications should be reviewed at check ups," Moreau says.
In some cases, a drug dose may be suboptimal, and in others too much, such that the side effects may be worse than the beneficial action of the medication.
Another issue is drug-drug interactions. Studies show women are more likely than men to take herbal or vitamin supplements, or to self-prescribe over the counter (OTC) medications--never realizing that these may interact with their prescription drugs.
"Many OTC medications are poorly tolerated by seniors and many people don't think of OTC medications as significant, but they are," Moreau warns.
Shelley Wood is a Kelowna-based medical journalist for WebMD and a regular contributor to Okanagan Q magazine.
Brain fitness? Keep the regimen fresh
In April, researchers at the Massachusetts Institute of Technology (M.I.T) made a startling announcement that may turn our notion of what the brain remembers--and forgets--completely on its head. Writing in the science journal Nature, Dr Li-Huei Tsai and her co-authors reported that mice genetically modified to experience a type of neurodegeneration similar to Alzheimer's disease in humans could have their memories restored.
As the scientists explain in their study, mice that appeared to lose early memories when their brain degeneration set in were able to regain these memories after being housed in an "enriched environment": cages filled with new toys and exercise wheels. Far from being "erased" these memories were essentially misplaced within the mice brains, then re-accessed after the mice were given new challenges and stimulation.
Dr. Mary Ann Murphy is an associate professor at UBC Okanagan who specializes in the sociology of aging and has developed a program focusing on aging within the UBC School of Social Work. "This is probably one of the most dramatic findings we've had in brain research, at least in the last year," she commented. "This is the first evidence that even if the brain has suffered some kind of damage, and an individual exhibits a lot of impairment, there is still the ability to improve learning ability and to recover. That's quite staggering."
Murphy points out that this and other research challenge the notion that brain decline is inevitable. A host of other studies, for example, suggest that even as the brain and the pathways that feed it may become restricted with time, new pathways form in compensation, a process dubbed neuroplasticity.
Increasingly, researchers are insisting that the brain, just like the body, can and should be exercised in order to function at its best. Emerging evidence suggests that the key to keeping the brain fit seems to be not just rote exercise, but ever-varying mental challenges. While crossword puzzles and the ubiquitous Sudoku force the brain to fire up, shine a flashlight into forgotten recesses, and look for clues or patterns, research suggest it's also necessary to seek out completely novel tests and riddles for the brain to mull over.
"This is really a remarkable discovery that suggests that it's necessary to maintain brain stimulation through life-long learning, and most important, engaging your brain in non-familiar patterns: that could be driving a different route to the store, or learning something new around the house--just thinking of different ways of doing thing," Murphy said. "It's not just exercising the brain, it's exercising it in a way it's not used to.
Learning to dance, or to paint, she says, "are very good examples of stimulating the brain in new ways."
Copyright © 2007 Shelley Wood. All rights reserved.
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