March 10, 2022
“Sixty is the new 40; 80 is the new 50,” said Dr. Thomas Lawrence, one of two board-certified geriatricians who shared their expert perspectives on aging in a recent Barclay Friends video event, “What It Means to Have a Healthy Old Age.”
Dr. Lawrence is medical director at Barclay Friends and Kendal Crosslands, system medical director of geriatrics in long-term care for Main Line Health, and a private practitioner in nearby Newtown Square. Joining him was Dr. Robert Brus, an internal medicine physician specializing in long-term, post-acute geriatric care, former chief quality officer and president of the medical staff at St. Francis Hospital, and an attending physician at Barclay Friends.
What Defines Old Age Today?
While the retirement age of 65 was arbitrarily chosen in the early 1960s, “old age” marked by frailty and multiple chronic conditions is now more like 85 and above – the so-called “extreme seniors.”
“Now we know that everything applying to senior care is for a significantly older population than 65,” said Dr. Lawrence. “The ‘Golden Years’ when we have good functional health are now 65-75.” Agreed Dr. Brus, “The definition of old age today is a moving target.”
Changes in healthy aging and life expectancy are the result of several factors we explored in a recent blog. Perhaps as a result, fewer physicians are entering the shrinking field of geriatrics. Dr. Lawrence and Dr. Brus are the exceptions who were drawn to the care of the elderly early in their careers.
Are Aging and Disease Synonymous?
Not necessarily, according to Dr. Lawrence. “One assumption in general culture is that the older we get, the more like each other we become. But nothing could be further from the truth.” In fact, he noted, the senior population in the U.S. is more diverse than younger populations.
The bigger determinants in developing disease as we age are genetics and lifestyle.
Citing common age-related conditions such as hypertension, elevated cholesterol, heart disease, diabetes, arthritis, cerebrovascular disease, congestive heart failure, chronic kidney disease and Alzheimer’s disease, Dr. Brus said these issues are more easily controlled than prevented. Healthy lifestyle choices, regular doctor visits and proper medications can help manage common problems associated with advanced age.
How Important Is Lifestyle?
We’ve heard it before, but the value of healthy lifestyle choices – particularly as we age – truly cannot be overstated. Here’s how we can likely affect how well we age:
Eat a healthy diet
“You are what you eat really is true,” said Dr. Brus, who served on a medical nutrition team when he was a hospital specialist. “Diet alone can control and treat many conditions.” Warning that Americans have been programmed to crave ubiquitous fast foods, sodium, fats and sugars, Dr. Brus said it is “extraordinarily important” to consume foods low in these additives (sodium in particular) and high in the nutrients older people need most, such as calcium, vitamin D and potassium.
Maintain a healthy weight
Obesity in the United States is rampant, beginning at a young age. Not only does being significantly overweight inhibit an already decreased capacity for physical activity as we age, it greatly increases the chance of developing heart disease, high blood pressure, stroke, and some types of cancer.
Get regular exercise
Even at an advanced age, steady light exercise can delay myriad chronic conditions. In particular, Dr. Lawrence stresses the importance of stretching. “Even for me,” he remarked, “if I don’t stretch in the morning, my chronic back pain bothers me all day.” Dr. Lawrence also recommends endurance training through light walking and strength training with very light weights to improve balance and range of motion.
Chronic obstructive pulmonary disease (COPD) is prevalent in the elderly, and cigarette smoking is a chief cause. While difficult to give up, especially for those with a lifelong tobacco habit, smoking is a severe risk factor among the elderly. Smoking can also increase the risk of stroke and vascular dementia brought on by stroke.
What About Genetics?
“Unfortunately, you don’t get to choose who your parents are,” quipped Dr. Brus. But that doesn’t mean “the horse is out of the barn” and there’s nothing people can do if they have a genetic predisposition to certain conditions. Awareness, often through genetic testing, is key. Knowing one’s family history will help guide decisions, actions and appropriate therapies.
Is Dementia Inevitable?
A common myth about aging is that nothing can be done to reduce the risk of dementia and Alzheimer’s disease. According to one study, staying mentally and physically active and eating a healthy, balanced diet can prevent dementia in one in three cases. Even more hopeful are scientific advances that will bring new treatments and ways to stave off certain types of dementia. “Genetic predisposition is not a life sentence,” encouraged Dr. Brus.
How Restrictive Is Too Restrictive?
At a certain point, too many dietary restrictions and prescription medications cease to benefit an “extreme senior.” “In patients over 85, I rarely recommend changes in diet, except for sodium reduction,” said Dr. Lawrence. “I’d rather see my patients eat a little unhealthy than not eat at all,” concurred Dr. Brus, noting that malnutrition becomes a risk factor as we age, especially in those with cognitive decline. While acknowledging that advances in medications are increasing life expectancy and quality of life, Dr. Brus prescribes non-pharmacological therapies in patients over 85 as much as possible.
Does Mental Health Make a Difference?
Unquestionably, good mental health characterized by regular social interactions and engaging activities significantly affects overall healthy aging. Senior communities like Barclay Friends are instrumental in fostering new friendships (and even new romances) and new interests as well as keeping residents safe and secure, properly nourished, and in the care of qualified medical professionals. For seniors who are depressed or anxious, anti-depressant medications have more than a 60 percent success rate, according to Dr. Lawrence, and both doctors agree on the efficacy of psychotherapy – or “talk” therapy – with a qualified professional or even just a good friend.
Where Can I Find a Geriatrician?
Despite the decrease in physicians specializing in geriatrics, there is tremendous need for them among octogenarians and nonagenarians, said Dr. Lawrence. “A 70-year-old with a few issues doesn’t need a geriatrician,” he remarked. But it’s crucial to find a professional who can support seniors’ needs as they grow into advanced age. One route is a long-term care community, where there is a team approach to geriatric care and that’s all they do – from physicians to nurses, CNA’s, therapists and dietitians. Another suggestion is to investigate local geriatric training programs and doctors coming out of residency. Remarked Barclay Friends executive director and video event facilitator Linda Sterthous, “We want our doctors to be younger than us; we don’t want them to retire when we need them most!”
Also crucial to good geriatric care is a genuine passion for the field. Both Dr. Lawrence and Dr. Brus shared heartwarming accounts of what inspired them to pursue the care of elderly patients. For Dr. Lawrence, it was his beloved grandparents and the “thousands” of patients he’s had over the years whose life stories have kept him in awe. Dr. Brus shared the story of a patient who, early in life, had been electrocuted and clinically died. He was resuscitated and lived to write a book called “Dying to Survive” about his life-altering experience. “His attitude was infectious; he will forever be an inspiration to me,” said Dr. Brus.
Explore Extraordinary Living and Collaborative Senior Care
Barclay Friends offers a full continuum of care