What doctors wish patients knew about healthy aging

We’ve seen actress Betty White live to the age of 99 and, more recently, Queen Elizabeth II die at 96 after a 70-year reign. This has a lot to do with healthy aging, which shouldn’t begin as an older adult—it should be top of mind even in your college years. And while there are many factors that influence healthy aging, some of these—such as genetics—are not in our control. That is why knowing what steps to take is key.

Healthy aging is an ongoing process of maintaining and improving physical and mental health. This can help to ensure independence, security and productivity as you age. Yet millions struggle with health and safety challenges such as chronic disease, falls and mental health problems, which can severely impact quality of life.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.

In this installment, three physicians took time to discuss what patients need to know about maintaining physical and mental health as they age. These AMA members are:

• Edward T. Bope, MD, a family physician in Columbus, Ohio and officer-at-large of the AMA Senior Physicians Section (AMA-SPS) Governing Council.
• Jenny L. Boyer, MD, PhD, JD, a full-time telemedicine psychiatrist in central Oklahoma who is employed by the Department of Veterans Affairs at the West Texas VA health care system based in Big Spring, Texas. She is also immediate past chair of the AMA-SPS Governing Council. Dr. Boyer’s views are her own and do not represent the VA.
• Louis Weinstein, MD, an ob-gyn and maternal-fetal medicine specialist in Charleston, South Carolina.

“Healthy aging means avoiding illness as much as possible and dealing with illness when it occurs. We need to pay attention to this because how we age matters,” said Dr. Bope. “It really matters on the final outcome, the way you take care of the body, the way you preserve your ability.”

Additionally, “healthy aging is about prolonging the length of time you are aging without disability, the length of time you are able to do all the things you want to do and reducing the length of time you are aging with physical or mental challenges,” said Dr. Boyer. “A key focus of healthy aging is prevention and making healthy lifestyle choices in your 40s, 50s, 60s, 70s so that your 80s and 90s are healthier.”

“Without the component of health, it’s a very difficult time for most people and, ultimately, all of us are going to experience some abnormalities in our health,” Dr. Weinstein said. “It’s only a matter of when, not if, but clearly there are ways to prolong the onset of conditions that will affect your health.”

“It’s a lifelong habit to take care of yourself, but it also matters what happens when you go through different phases in your life,” said Dr. Bope, adding that it is “the phase when children leave home, the phase when you retire, how you become acclimated to a new social situation, how you take care of yourself in regards to your diet and how you would take care of yourself in the way of exercise.”

“Now, all of this really has a lot to do with what your abilities are, and we’re given different abilities,” he said, noting that “some people don’t have as good a musculoskeletal system as others as they age, and some people will have memory problems earlier than other people or vision problems or hearing problems.”

“It’s optimal, of course, when all of those things continue at their previous level and all you have to do is just maintain them,” said Dr. Bope. “It’s more difficult when some of them start to change and you have to adapt to that.”

“I can’t tell you how many senior patients—and even women in their fifties—are having mobility problems. It’s just extraordinary,” Dr. Weinstein said, adding that “mobility is one of the keys to physical well-being.”

“A simple check is to see if you can get out of a chair without using your arms,” said Dr. Boyer. “If you struggle with this, you might talk to your doctor about physical therapy or an exercise program to improve core strength and prevent loss of mobility.”

“People talk about how you need to run, jump, weight lift or swim, but I don’t care what type of mobility it is,” Dr. Weinstein said. “If you’re getting up and down from a chair, that’s mobility. Pushing against the wall, that’s mobility. Just maintain mobility in any form.”

American journalist “Norman Cousins wrote a great article in the The New England Journal of Medicine years ago about his chronic disease and how his attitude markedly influenced his chronic disease,” explained Dr. Weinstein. “So, attitude is important. Every one of us is going to have setbacks, unquestionably, but how you approach the setback is what effect it will have on you as you age.”

“And you can adjust your attitude. There’s no medicine for attitude. You can’t go take two Aspirin and get your attitude better,” he said. “But you can choose what your attitude is and how you approach situations knowing that things are going to happen to all of us.”

“There are four very serious unhealthy habits: smoking, alcohol, salt intake and processed foods,” said Dr. Weinstein. “While there are all kinds of diets, if you can decrease your salt intake and limit processed foods, you can improve your health.”

“In aging—as in all ages—it’s good to have a balance in your nutrition,” said Dr. Bope. “You really should still be having a good breakfast, which is something many older people skip, but that’s a good foundation for the day. And then tapering your calories off a little bit as the day goes on.”

“A healthy diet and exercise are good for everyone, regardless of age,” said Dr. Boyer. “But if you are losing weight, make sure you let your doctor know so you aren’t missing something that could be treated.”

“One issue that really can affect so much of what a senior does through healthy aging and emotional stability is vision. We know that vision deteriorates as we age—whether it’s cataracts, age-related macular degeneration or diabetic retinopathy—but so much of vision can either be corrected, maintained or stabilized,” said Dr. Weinstein. “If you lose vision, you lose so much because you lose your ability to function easily in the world, which has a huge emotional impact.

“Hearing can be corrected by hearing aids, but vision is something that seniors don’t focus on until they start to lose it or do lose it,” he added. “In my personal experience, when I developed cataracts, I was having great trouble in examining patients and when I had my cataract surgery it revolutionized my ability to practice and to drive.”

“We need to focus very much on vision for everybody, but specifically for seniors,” Dr. Weinstein said.

“Physical health is important because it does help with your balance and it helps with building bones and keeping and maintaining some muscle strength,” said Dr. Bope. “Often, falls become a problem for aging people.

“And, to a degree, you can mitigate that by having good balance, good muscle strength and strong bones,” he added. “We’re not talking about weightlifting or jumping jacks. Just move around a little more by lifting cans of tomatoes, doing some of those everyday activities like lifting your legs, pressing against things. Even simple things can be helpful.”

“A lot of things play a role in healthy aging. Genetics is one of them,” said Dr. Bope. “People do tend to live longer in older families and people also tend to get illnesses based on their family histories such as heart disease and some cancers. Those are things that can be part of your heritage as well as lifestyle choices.”

But paying attention to family history “gives you an idea of what things to look out for,” he said. “If you’re in a family with history of colon cancer, for instance, you’re hyper aware of that and you don’t dare ignore any symptoms.”

“Hearing loss is somewhat inherited, and some types of blindness are also inherited,” Dr. Bope explained. “So, all of those things, if they’re in your family you can look for ways to mitigate them, avoid them altogether or deal with them.”

“You have to get into the habit of completely relaxing after you work or other activities because if you have chronic stress, that’s not a healthy lifestyle and it won’t be healthy aging either,” said Dr. Boyer. “That is where developing some recreational activities can help such as reading, going for walks, cooking, knitting, gardening, joining group activities.”

“But it’s hard to develop recreational skills in your eighties and nineties, so that’s why a lot of people do what they did as children,” she said. “In my example, I was raised outside on a farm, so I walked the creeks and now I am walking in my neighborhood.”  

“When doing this, though, you need to be realistic about your expectations and what you are able to do,” said Dr. Boyer. “If you can’t do something, adjust your expectations and find what works for you.”

“Interesting new studies are coming out, showing us that a decrease in hearing can lead to isolation, loneliness, depression and even dementia,” said Dr. Bope. “So just a simple thing like not being able to hear what's going on around you can affect how you age, but also impact your mental health.”

“In these stages of your life, you also have different social groups around you and different amounts of people,” he said. “And as you get to the extremes of aging, you may have less people around you and less stimulation, so some people become discouraged or depressed just by being isolated and loneliness is a significant factor in overall happiness and in health as well.”

“The way to get financial stability is to start when you’re very young. It doesn’t matter what you start with or how much you can, just do whatever you can do,” said Dr. Weinstein. “But the time to do it is when you’re young and to obtain some financial literacy.”

Additionally, “think about who you might designate to manage your financial affairs if you were one day not able to do so for yourself and make sure you talk to that person about what you would want them to do,” said Dr. Boyer. “The same thing goes for health care decisions.”

“The most important thing is you always have time to try to change things but try to change in small increments. Don’t try to change immediately,” said Dr. Weinstein. “For example, if you’re smoking 10 cigarettes today, next week let’s go to eight. Then the following week go to six because some people can’t tolerate stopping cold turkey.”

“You want to have positive feedback for yourself. You want to feel good because if I knew that you smoked 10 a day and now, you’re down to eight, you just did a 20% decrease and that’s fantastic,” he said. “You can also volunteer somewhere or if you’re into sports, do that to improve your quality of life too.

“If you can find something you enjoy, it’s going to make all the difference,” Dr. Weinstein said.