Working well with your own emotions is key to creating a healthy, happy life. Psychologist Dr. Daniel Goleman coined the famous term emotional intelligence in his book by that name. It refers to the ability to perceive, control, and evaluate emotions. I believe that emotional intelligence becomes even more important as we age.

Unfortunately, our modern society often projects negative attitudes and stereotypes about aging and older people. Therefore, it becomes very important to nurture our emotional health as the years pass. There are challenges that arise as we grow older, but it can also be one of the most rewarding times of life if we approach it with the right mindset.

Related Content: How Aging Affects Your Sleep and What To Do About It  

Nurturing your emotional health in later years

Here are five pieces of advice for nurturing your emotional health in your later years

1. Think positively about aging

The good news is that older people are naturally happy people, despite whatever challenges aging may bring. The Los Angeles Times reported on a survey of people in San Diego, CA, about their level of happiness.[1] It showed that people in their 20s were the least happy. And, surprisingly, people in their 90s were the happiest! The older they were, the happier they became through the entire life span, something that brain scientists call “the paradox of aging.”

This does not mean that all older people are as happy as they can be. Nor does it mean that they all have great attitudes about aging. Many people do pick up negative attitudes about aging, and this can negatively affect the aging process. For example, it is well known among older adults that exercise can help reduce the effects of aging [2], but negative attitudes about the aging of the body stop many people from exercising as they get older.[3]

A positive attitude about aging is especially important for the brain. A study published in the scholarly journal Psychology and Aging shows that people with a poor attitude about aging had greater cognitive decline than those who approached aging more positively.[4]

Related Content:  Do Optimism and Pessimism Impact Health Outcomes?

Also, while things like processing speed and memory decline with age, some things, like verbal ability and crystallized intelligence, improve or remain stable with age.[5][6] Further, it is possible to foster brain changes in ways that steadily increase your wisdom.[7]

Content on Brain Changes: How Mindfulness Changes Your Brain

2. Change your relationship to time

I wrote a book called I’ve Decided to Live 120 Years: The Ancient Secret to Longevity, Vitality, and Life Transformation. In it, I encourage people to set the goal of living to 120.

I focus on the age of 120 years because that does seem to be the approximate upper limit of human life span [8]. The oldest living person whose age was verified was Jeanne Calment of France, who lived to 122 years of age.

That doesn’t mean, however, that I believe everyone will live to 120 just by setting a goal to do so. Many people will fall short of that even if they live a very healthy lifestyle.

Perceiving that as a goal and a possibility, however, rather than focusing on the average of 70 or 80 years, will help you see a long-range possibility for your life instead of assuming that your older years are all about decline and impending death.

–Half of people will live beyond the average

You can imagine how a person who is turning 65 will have a different attitude about their remaining years if they think “I might have 50 or more years left” instead of “I probably only have 15 years left to live.” Remember, at least half of people do live beyond the average. And there is much you can do to make those years happy, healthy, and productive.

This 120-year attitude is important for understanding that you always have time to learn and grow and to set exciting goals for yourself.


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A study published in the Society for the Psychological Study of Social Issues shows that older workers avoid professional growth opportunities because they perceive themselves and being “out of time,” whether that is true or not.[9]

Even if you live a shorter-than-average life span, don’t you want to be active and involved in life for as long as possible? An ambitious young person thinks they can do a lot in five or ten years, and so can you.

3. Set a great vision for your life

I encourage people of any age to set a grand vision for their lives, one that will satisfy them physically, mentally, and spiritually. This might look different at 50 or 70 than it did at 30. Young people have a need to establish their households and their professional status in the world.

One of the blessings of age is that you probably have less concern about material success and social status because you have already established yourself in the world. Further, you most likely have developed the wisdom that allows you to see that these things are not the ultimate source of happiness. This may well be the reason why older people are naturally happier. This allows you much greater freedom to establish a vision for your life that is truly satisfying.

Ultimately, it is you who should establish the parameters of the goals you set for yourself. Ask yourself, “What will help complete my journey here on earth and give true fulfillment to my heart?” The answer, if you are honest with yourself, will probably be something that is of true service to humanity.

The world badly needs the wisdom of its elders, so look for the thing that makes your heart happy while also making the world a better place. It could be working with young people, expressing yourself through the arts, getting involved with civil rights. Do whatever uplifts your heart while also providing challenges that keep your body and mindfully engaged.

Mind and Body Health:  Can Journaling Improve Your Mental Health?

 4. Practice acceptance and gratitude

Although older people are overall happier than younger people, it doesn’t mean that there are no emotional struggles. As we get older, many of our friends and family pass away. We may have to face difficult illnesses, we might miss our old careers. Finally, a rapidly changing world might make us feel out of touch and out of sorts.

It’s important to remember, though, that you have a great deal of control over how to respond to these challenges. There will be times of resentment and sadness. However, ultimately you can choose how long you will hang on to those feelings before you replace them with acceptance and gratitude.

In the end, nothing in this life is permanent. Eventually, your life will end and everything you know about this world must be left in the hands of the generations that come after you. Do your best to forgive anyone who has harmed you and relinquish your control over other people, society, and the future. The best thing you can do is to guide them and bless them in whatever way you can without any attachment to the outcome.

Read More Here:  
The Science of Mind-Body Therapy for Pain
Body Dysmorphic Disorder: Obsession With a Flaw Interferes With Life
How Gratitude Can Change Your Life for the Better

5. Leave a legacy of love

Sometimes, people speak in negative terms about the “graying” of society. This is the trend for people to live longer that results in more older people relative to the number of young people. Studies have found that the negative impact of that is exaggerated and that we can make choices, such as encouraging older people to remain productive, that establish balance.[10]

Most importantly, you can determine that you will be a person that has a positive influence on people around you and on the world as a whole, regardless of your age. Really, leaving the world a better place is the ultimate legacy anyone can leave. We can all do that if we choose.  

References:

[1] Netburn D. The aging paradox: The older we get, the happier we are. Los Angeles Times. Published online August 24, 2016. Accessed February 19, 2021. httpss://www.latimes.com/science/sciencenow/la-sci-sn-older-people-happier-20160824-snap-story.html

[2] Sabau E, Niculescu G, Gevat C, Lupu E. The attitude of the elderly persons towards health-related physical activities. Procedia – Social and Behavioral Sciences. 2011;30:1913-1919. doi:10.1016/j.sbspro.2011.10.372. Accessed February 19, 2021. httpss://www.sciencedirect.com/science/article/pii/S1877042811021975

[3] Andrews RM, Tan EJ, Varma VR, Rebok GW, Romani WA, Seeman TE, Gruenewald TL, Tanner EK, Carlson MC. Positive aging expectations are associated with physical activity among urban-dwelling older adults.  Accessed February 19, 2021.The Gerontologist. 2017;57(suppl_2):S178–S186. doi:10.1093/geront/gnx060. httpss://academic.oup.com/gerontologist/article/57/suppl_2/S178/3913377  Accessed February 19, 2021.

[4] Siebert JS, Wahl H-W, Degen C, Schröder J. Attitude toward own aging as a risk factor for cognitive disorder in old age: 12-year evidence from the ILSE study. Psychology and Aging. 2018; Volume 33(3):461–472. doi:10.1037/pag0000252. httpss://psycnet.apa.org/record/2018-21485-007 Accessed February 19, 2021.

[5] Trafton A. The rise and fall of cognitive skills. MIT News. Published online March 6, 2015. Accessed February 19, 2021. httpss://news.mit.edu/2015/brain-peaks-at-different-ages-0306

[6] Perera A. Fluid vs crystallized intelligence. Simply Psychology. Published online December 14, 2020. Accessed February 19, 2021. httpss://www.simplypsychology.org/fluid-crystallized-intelligence.html

[7] Ananthaswamy A. The wisdom of the aging brain. Nautilus. Published online May 12, 2016. Accessed February 19, 2021. httpss://nautil.us/issue/36/aging/the-wisdom-of-the-aging-brain

[8] Ruiz-Torres A, Beier W. On maximum human life span: interdisciplinary approach about its limits. Adv Gerontol. 2005;16:14-20. httpss://pubmed.ncbi.nlm.nih.gov/16075672/ Accessed February 19, 2021.

[9] Kooij D, Zacher H. Why and when do learning goal orientation and attitude decrease with aging? The role of perceived remaining time and work centrality. Journal of Social Issues. 2016;72(1):146-168. doi:10.1111/josi.12160. httpss://spssi.onlinelibrary.wiley.com/doi/abs/10.1111/josi.12160 Accessed February 19, 2021.

[10] International Institute for Applied Systems Analysis. Effects of population aging have been exaggerated, new analysis suggests: More appropriate retirement ages?. ScienceDaily. Published online September 10, 2010. Accessed February 18, 2021. httpss://www.sciencedaily.com/releases/2010/09/100909141523.htm


 


Financial Disclosure: Contents of this post are related to, but not quoted from, Ilchi Lee’s book, I’ve Decided to Live 120 Years: The Ancient Secret to Longevity, Vitality, and Life Transformation***. This book also served as the basis of a prior post on TDWI, These 8 Life-Changing Tips Will Help You Age Well.

Does your mom or dad’s car suddenly have more dents and scrapes than usual? Have they recently been ticketed for several traffic violations, putting an end to their streak of flawless driving? If so, it may be time for you to discuss reducing their time behind the wheel — or stop driving altogether.

Asking your older parent to stop driving can be extremely difficult. In fact, a survey conducted by Pfizer and Generations United found more respondents said the hardest conversation they had with their senior parents was not their finances, final wishes, or wills. It was about driving.

Seven helpful tips to talk about taking away the car keys

If it’s time for your aging parent to give up their keys, consider these seven tips to help your conversation go a little smoother.

1. Be sympathetic

 For most adults, driving is an essential form of freedom. It’s important to recognize that you aren’t just asking your parent to give up their keys. You are asking that they radically change their lifestyle. If they can’t drive, they may have to alter their daily routines, who they see, and the places they go.

No one likes it when someone tells them they shouldn’t do something anymore, even if they already know it themselves. You may be met with frustration, hostility, or denial. Remember to remain calm and keep your emotions in check. A family meeting to talk with your parents may make them feel as though everyone is ganging up on them — instead, ask a trusted family member to have a one-on-one talk with them.

2. Know the facts

One ticket doesn’t necessarily mean your parent should stop driving. An empty claim that they’re an unsafe driver will likely fall on deaf ears. Ride with them and take note of any behaviors that seem unsafe so that you have specific examples to point to when you explain why they should no longer be behind the wheel.

It’s important to also have a clear picture of your parent’s health. How did they perform on their most recent eye exam? What medications are they taking? Can any of them affect their driving?


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Has their doctor recommended that they limit their time driving? Knowing the answers to these questions will help you have an informed conversation.

3. Research transportation alternatives

Before you ask for your loved one’s keys, come up with a plan for how they will manage without a car. Research transportation options near your parent’s home and the areas they go to the most.

      • Public transportation

Find out whether your community offers seniors special low-cost transportation services or discounted fares on public transportation. Your county’s Area Agency on Aging can connect you with available local programs.

      • Rideshare options

If public transportation isn’t an option, ridesharing apps like Uber or Lyft can be a convenient option. Consider getting your parent a smartphone (if they don’t have one already). Then offer to ride along with them on a few trips so they can see how ridesharing works. If money is a concern for your parent, see if you can add family members to your account so that they can help cover the cost.

      • Family and friends

Family and friends may also be able to fill in any transportation gaps. Consider picking a day of the week when you or another family member is available to drive your parent around to do errands and meet up with friends. Plus, with services like Amazon Prime and other regional grocery and pharmaceutical delivery options, your parent can get almost everything they need to be mailed to them.

      • Transportation to medical visits

Although the pandemic has spurred the development of virtual alternatives to in-person medical appointments, some conditions may require in-person medical visits. Explore the options for free or low-cost transportation with their doctor’s office or health system. Check with locally available rideshare options – some offer transport in specially equipped vehicles with drivers trained to deal with limitations due to age or infirmity. Also, explore the availability of free, volunteer-run transportation options. Many nonprofits, like the American Cancer Society, offer free transportation and many churches offer rides to medical appointments as well.

After researching all these options, you will be better equipped to respond to your parent’s claims that they have to drive.

4. Take the long-term approach

It takes time to get comfortable with the idea of a major lifestyle change. So don’t expect your parent to agree with you the first time you suggest they stop driving. Give them some space between each conversation. This will allow them to process the information and cool off.

It helps if you don’t wait until they’ve gotten into an accident to point out a decline in their driving capabilities. Whether it’s a new medical diagnosis or declining eyesight, start the conversation as soon as you see the first signs of aging. Start small by suggesting they give up driving long distances, in inclement weather, or at night.

After a period of time, it may make sense for your parents to drive only in familiar neighborhoods and rely on family members or public transportation some of the time. If they’re driving part-time already and know that they can get around without a car, it will likely be much easier to ask them to stop driving altogether.

Related Content:
Do You Know the Health Risks of Driving?
Are the Decisions You Make for Your Elderly Parents Biased?

5. Suggest they go to the DMV

Your word may not be enough to convince your parents to stop driving, and having a professional tell them that their skills are no longer up to par may be the push they need to use other transportation methods.

Suggest they take a refresher course for senior drivers through their local AAA or DMV. If they are confident that they can drive, they shouldn’t be worried about their ability to prove it.

In some states, a doctor can request that the DMV test a driver again if they have concerns about their ability to be safe behind the wheel. Consider asking your parent’s doctor (with permission of your loved one) if the DMV should test your mom or dad as a new driver, written tests, and all.

An occupational therapist can also evaluate your parent behind the wheel and offer a medical perspective on their ability to drive. They may suggest modifications to help them drive more safely — like larger mirrors, cushions, or hand pedals. Or they may recommend that your parent stop driving altogether.

6. Point out the consequences

The likelihood of dying as the result of a car accident sharply rises after the age of 65. This is mostly because older bodies can’t withstand hard impacts as easily as younger bodies can. Your parent likely knows that they can no longer bounce back from minor falls like they used to. Make sure they know that car accidents are no different.

If you’re really struggling to get through to your parent, point out how their decision could affect others. For example, ask your parents if they feel confident in their abilities to drive their grandkids safely around town. They may be willing to risk their safety, but the thought of their grandkids getting hurt could bring them back to reality.

7. Always remember the point of your conversations

 If you are getting impatient with how long your conversations are taking, or how stubborn your parent is acting, remember why you’re having these conversations in the first place. You want them to be safe.

Finally, put yourself in your mom or dad’s shoes. When you get to be their age, how would you want your children to talk to you about your driving?


Published 12/16/18. Medically reviewed and updated 2/28/21.

About two weeks, after I fractured my shoulder a few years ago, I got a phone call from Kaiser Permanente, the health system where I get my care. The woman on the line identified herself as being part of my medical center’s Bone Health team. She said they were calling me because I had sustained a fracture that is suggestive of low bone density. She called it a fragility fracture.

What are fragility fractures?

Fragility fractures are fractures that occur as a result of low energy trauma, for example, falling from a standing height – or no trauma at all [1].

Common fragility fractures include the following:

      • vertebral fractures,
      • humeral head (shoulder) fractures,
      • fractures of the neck of the femur (a.k.a. hip fractures), and
      • Colles fractures of the wrist.

It turned out that Kaiser routinely scans its electronic health records in order to identify patients with these types of fractures so they can bring them in to evaluate their bone health.

How a population health program can help identify “silent” osteoporosis

My first reaction to hearing that I had a fragility fracture was “I am not fragile, I just tripped and fell.” But the Bone Health lady pointed out that people with normal bone health don’t usually fracture their big bones (humerus or femur) when they fall from a standing height. She said I needed to come in for a bone density test and blood tests to measure my vitamin D level (amongst other tests) to determine my risk of fragility fractures.

I was impressed. I am a long time fan of population health programs [2] and have seen health plans and provider groups use them to proactively reach out to people with diabetes, heart failure, and asthma.

At the time, I had never come across a population health program that targeted osteoporosis even though, according to the National Osteoporosis Foundation, 54 million Americans have either osteoporosis or low bone density (osteopenia).[3] Not only that, but 1 in 2 women and 1 in 4 men over the age of 50 will break a bone due to osteoporosis.

Think about that for a minute! That’s an awful lot of people who will experience the pain, suffering, and cost of a bone fracture that perhaps could have been prevented if their low bone density had been detected earlier.

Routine screening for osteoporosis

Hopefully, you won’t wait until you sustain a fragility fracture before being evaluated for your risk of sustaining one. In fact, the USPSTF, a respected organization that reviews guidelines for the prevention of health conditions has concluded with moderate certainty that there is “at least moderate benefit” of screening for osteoporosis in the following individuals [4]:

  • women 65 and older 
  • postmenopausal women younger than 65 years who are at increased risk of osteoporosis is at least moderate

However, they found that current evidence is “insufficient to assess the balance of benefit and harms of screening for osteoporosis in men.” This was primarily based on the lack of evidence for effective treatments of osteoporosis in men.

The USPSTF report states that,

“…it cannot be assumed that [effective treatments for women] will be equally effective in men because the underlying biology of bones may differ in men due to differences in testosterone and estrogen levels.”

Bone mineral density (BMD) tests

 Bone density tests—also called Bone Mineral Density (BMD), DXA, or DEXA (for dual-energy X-ray absorptiometry) test are very important in making the diagnosis of low bone density (osteopenia or osteoporosis).[5]

In addition, they are used to predicting the risk of fractures, particularly when used in conjunction with a bone fracture risk prediction tool, such as the Fracture risk assessment (FRAX) tool (see below). Finally, BMD tests are also used to assess changes in bone density over time and to monitor the effects of treatment.

The BMD machine works by firing X-rays from two different sources through the bones that are being tested towards a detector. The use of two different X-ray sources rather than one allows a more accurate reading of bone density. Mineralized bone blocks a certain amount of the X-rays. The denser the bone is, the fewer X-rays get through to the detector.

There is no special preparation required for the test, although you should let your physician know ahead of time if there is a possibility you are pregnant or if you recently had a barium exam or received an injection of contrast material for a CT or radioisotope scan. Some also recommend that you refrain from taking calcium supplements for 24 hours before the test as they could interfere with the images.[6].

You will be asked to remove any jewelry and change into a hospital gown. Then, you will be positioned on your back on a special examination table. For part of my exam, I had a rectangular-shaped foam pillow placed under my knees and I was asked to remain very still while the machine was actively scanning the bones of my back (the vertebrae) and hip.

If you are unable to lie down so that the spine and hip can be imaged (these provide the best images to predict the risk of osteoporotic fracture) you may instead have a DXA scan of your forearm to establish the diagnosis of osteoporosis.

The total time for the test—scan time plus repositioning time—is about 10 to 15 minutes, depending on which parts of your body are being examined. I was walking back to my car 20 minutes after I checked in for the test—and that included stopping at the lab for some blood tests.

Be sure your doctor is sent the images as well as the summary test results for the best understanding of the findings.

By the way, is important to know that a BMD test is not the same thing as a bone scan that may be used to look for other types of abnormalities in your bones, such as metastases from cancer, infection, or inflammation.

The FRAX tool

At some time before you get your BMD test, you will likely be asked to fill out a FRAX Fracture Risk Assessment Tool.[7] It will look something like this. Information from this test is used to calculate your overall fracture risk as will be explained below.

FRAX Questionnaire screenshot

Please click on the link to get more detailed instructions about how to fill out the form. (Screenshot of FRAX Questionnaire from https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9) 

There are a number of other risk assessment tests available but the FRAX is the most commonly used at the present time.

Understanding the results

The data from the X-ray detector is sent to a computer which calculates a score of the average density of the bone in grams/cm². The computer program compares your score to groups of people of the same ethnicity and gender to calculate two different scores, a T-score and a Z score. When you get the results (and you should ask for a copy of the full report) it will look something like this:

“A bone mineral density (BMD) measurement was performed of the L1-L4 vertebrae and the proximal femur (total femur, neck, trochanteric, and intertrochanteric region) using a Hologic Dual Energy X-ray Absorptiometry Model Discovery C machine.”

  • Have repeat tests done using the same make and model as prior tests

You will want to know the name and model of the machine as it is important in determining your fracture risk. It is also important for your clinician to know this information because the results may vary by the type of machine used. Comparing the results to a prior test done on a different make and model of machine can be problematic.

  • Your values are compared to a reference population

The test result will also describe the measurement values and the comparison group:

“BMD values were determined in gms/cm² and compared to a young normal
reference population (T-score = standard deviations (SDs) below or above the young normal mean), and to an age-matched normal reference population
(Z-score = SDs below or above the age-matched normal mean).”

  • The T and Z scores are both important

The T and Z scores are both important when interpreting the results and deciding if you need treatment. The T-score compares your bone density to that of young normal individuals. Bone density peaks somewhere between 18-35 years old. After that, there is a steady loss of bone that accelerates after menopause and doesn’t slow down again until the age of 70 or so. 

The T-score tells you how much bone you have lost compared to an average peak value of young healthy individuals of the same sex and ethnicity. The Z-score compares your bone density to that of people of the same gender and ethnicity and approximately your same age.

If this score is lower than the reference population, it suggests you are losing bone faster than the average for your peers. This alerts you and your doctor that something other than “normal” bone loss due to aging may be going on.

For example, excessive bone loss may be due to taking certain kinds of drugs, such as glucocorticoids, aromatase inhibitors, or certain types of anti-epilepsy drugs. This type of osteoporosis is referred to as secondary osteoporosis (secondary to a factor other than aging).

  • Understanding caveats about the reference group

Information will be provided that will help you and your doctor understand some details about the comparison group. Mine test results included this statement:

“Reference BMD values for the hip were derived from the NHANES data and for the spine from the Hologic reference data. According to the WHO, criteria osteoporosis is defined by T-scores but you should note that these are only defined for a Caucasian female 65 years or older.”

  • Best practices in BMD testing

According to an excellent review of best practices for Bone Mineral Density testing published in Volume 19 of the 2016 Journal of Clinical Densitometry (yes, there is such a journal)[8]:

“Manufacturers are advised to use National Health and Nutritional Examination Survey III young adult Caucasian female BM data as the reference standard for femoral neck and total proximal femur T-score calculation.”

They can use their own reference data for lumbar spine T-score calculation.

This review makes it clear that, as is true of most things in medicine, the devil is in the details. BMD tests need to be performed properly with well-trained technicians and properly calibrated and maintained machines. The interpretations must be done by people who know what they are doing and understand the critical importance of applying the correct comparisons.

Embarking on treatment for osteoporosis requires that best practices be followed.

“A normal T-score is between 0 and -1.0. Osteopenia is defined as a T-score of -1.1 to -2.4. Osteoporosis is defined as a T-score of less than -2.5.”

Assessment of risk of fragility fractures

The T-score is only one piece of information that is used to estimate the risk of having an osteoporotic fracture over the next 10 years. Although there are several fracture risk predictors available, the one most commonly used is the FRAX tool (shown above). You can find an online FRAX calculator here: www.shef.ac.uk/FRAX

The FRAX tool calculates risk based on age, gender, BMI, and the clinical risk factors reported obtained from a questionnaire filled out at the time of the bone density test (see above).

You can get an estimate of your risk even if you have not yet had your BMD test. But it is more accurate if you are able to include the measured density of your femoral neck—note that you will be asked to include the make of the machine used for your test.

The clinical risk factors considered by FRAX are:

  • a previous fracture
  • a parent who fractured a hip
  • current smoking
  • use of glucocorticoids
  • rheumatoid arthritis
  • a diagnosis of secondary osteoporosis
  • alcohol intake greater than 3 units per day

This is how this information appeared in my report:

“10-year fracture risks were calculated using the World Health Organization FRAX tool based on the age, gender, BMI, clinical risk factors reported by the patient, and the BMD of the femoral neck measured. Clinical risk factors considered by FRAX are: previous fracture, parent fractured hip, current smoking, glucocorticoids, RA, 2nd osteoporosis, and 3 or more alcohol units per day.”

The FRAX score (estimated risk of having an osteoporotic fracture over the next 10 years) is reported as two different risks: The percent risk for any major osteoporotic fracture and the percent risk for a hip fracture.

Who should be considered for treatment?

My report also contained the following language about treatment:

“National Osteoporosis Foundation recommends to consider initiating therapy:

1) postmenopausal women and men age 50 and older with hip or
vertebral fractures, or fragility fractures
2) DEXA BMD T-scores -2.5 or below (after excluding secondary reasons for
osteoporosis)
3) For osteopenic patients: 10-year hip fracture probability < 3% or a 10-year major osteoporosis-related fracture probability < 20% based on the US-adapted WHO absolute fracture risk model FRAX…

…all treatment decisions require clinical judgments and consideration of clinical risk factors that may or may not have been captured in the FRAX model and possible under-or-over estimation of fracture risk by FRAX.”

Missing from the report, but very important is the patient’s preference. Failure to take this into account may be one reason why so many people refuse to initiate treatment, fail to take medications as prescribed, or discontinue treatment that could be beneficial. We will, of course, dive into all of the issues related to the treatment of osteoporosis in a future post.

Want to share your personal journey?

Meanwhile, please leave a comment or contact me at [email protected] if you would like to share your personal journey with osteoporosis. Please do not leave comments asking for medical advice as that is best discussed with your doctor.

References:

  1. van Oostwaard M. Chapter 1: Osteoporosis and the Nature of Fragility Fracture: An Overview, In Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient [Internet], 2018, June 16. https://www.ncbi.nlm.nih.gov/books/NBK543829/
  2. Dentler J, Davidson J. 10 Core Components of a Successful Population Health Program, 2015 June 25, Becker’s Hospital Review. https://www.beckershospitalreview.com/hospital-management-administration/10-core-components-of-a-successful-population-health-program.html. Accessed 2/11/21.
  3. National Osteoporosis Foundation. Bone Health Basics: Get the Facts, Accessed 2/11/21. https://www.nof.org/preventing-fractures/general-facts/
  4. USPSTF Final Recommendation Statement. Osteoporosis to Prevent Fractures: Screening, 6/26/18. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/osteoporosis-screening
  5. Lewiecki E. Prevention of Osteoporosis, UpToDate (Official reprint) Wolters Kluwer. Accessed 2/11/21. https://www.uptodate.com/contents/prevention-of-osteoporosis/print
  6. Finkelstein J, Yu E. What Does Bone Density Testing Do and Why is It Important? UpToDate (Official Reprint) Wolters Kluwer, Accessed 2/11/21. 
  7. FRAX The Fracture Risk Assessment Tool calculator for the United States https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9
  8. Lewiecki E, Binkley N, Morgan S, et al. Best Practices for Dual-Energy X-ray Absorptiometry Measurement and Reporting: International Society for Clinical Densitometry Guidance, J. Clin Densitom. 2016 April-June. https://pubmed.ncbi.nlm.nih.gov/27020004/

First published on Aug. 3, 2016

Chronic wounds aren’t typically something most people think about. If there is a break in the skin or deep tissue, nature takes over and our bodies begin the healing process.

However, for some adults, especially those who are older or managing health conditions, wound healing – particularly if the wound is chronic – is not as easy.

Chronic wounds are common 

Every year, more than 6 million people in the U.S. are affected by chronic wounds such as pressure injuries and foot ulcers[1]. Unlike acute wounds from a surgical incision or an injury, chronic wounds often occur in people with conditions like immobility or diabetes.

These types of wounds don’t necessarily show signs of healing within 30 days. If wounds don’t heal properly, they can lead to some very serious complications.

Because of the associated complications, chronic wounds put a significant financial strain on the health system. It’s estimated that $25 billion is spent annually in the U.S. to treat these wounds. This, plus the inconvenience and setbacks of people afflicted with chronic wounds makes it critical that healthcare providers help patients reduce the risk of wound complications.

Risks factors for chronic wounds

Some of the factors that put a person at higher risk for chronic wounds, include the following [2]:

  • older age
  • hypertension
  • poor nutrition
  • chronic lung disease
  • diabetes
  • obesity 

Self-care can make a difference in chronic wound care

I am a nutrition scientist and researcher at a global healthcare company that produces science-backed nutritional therapies. I’ve specialized in wound healing for more than two decades.

My passion is to empower patients and their caregivers with self-care strategies to support continued wound healing at home, as directed by a physician. By focusing on the following areas of wound care, healthcare providers can help patients and caretakers stay on top of their care plan in order to achieve the best outcomes possible.

  • Ensure proper wound dressings and care

To ensure care is continued long after a hospitalization or clinic visit, clinicians should talk to their patients about the appropriate steps to clean their wound and keep a fresh dressing applied to it. This will help prevent germs from contacting the wound while absorbing fluid that drains from the site that could damage the skin surrounding it.

While the best methods for dressing will depend on the individual’s specific type of wound, there are general steps that patients and caregivers should become familiar with handling at home. These include,

      • cleaning the wound each time the dressing is changed,
      • applying a fresh dressing, and
      • possibly using a compression stocking or bandage to help improve blood circulation and promote healing[3].

Lastly, protecting the wound site is important. Patients should be coached to take steps to avoid any additional trauma to the wound. This can help reduce additional setbacks.

For example, if a person has a foot ulcer, it helps to make sure that any shoes or slippers are not aggravating the wound site. Further, directing patients to elevate the affected foot above heart level for 15 to 30 minutes a few times per day may help with swelling and improve blood flow.

  • Don’t underestimate the power of nutrition

Nutrition is often an overlooked part of wound care, however, it can support healing from the inside, out.

Our bodies are designed to heal skin and tissue damage, but only if they have the right tools to make it happen. Good nutrition is one of those critical tools.

For each stage of the healing process, specific nutrients are required. If a person isn’t getting enough of the right nutrients, the wound-healing process can be delayed.

The body needs additional calories as well as protein, amino acids, vitamins, and minerals to generate new tissue at the wound site.

Some of the specific nutrients to prioritize include the following:

        • arginine and glutamine, important amino acids during the wound healing process that provide building blocks for new tissue. 
        • Hydrolyzed collagen is necessary to stimulate the production of internal collagen at the wound site.
        • HMB (short for β-hydroxy-β-methyl-butyrate) helps slow muscle protein breakdown
        • Zinc supports immune function and skin integrity
        • Vitamins C, E, and B12 help strengthen the new skin and to help get more oxygen to the wound site.

It can sometimes be difficult for a patient to get enough of these key nutrients from diet alone, especially if they are malnourished or managing other health conditions.

Recovery during hospitalization or from illnesses can also take a toll on a patient’s appetite. It can also impact their ability to tolerate certain foods.

When a balanced diet is not enough, there’s a clinically-backed nutrition supplement that supports the wound-healing process by providing essential nutrients that have been shown to enhance collagen formation in as little as two weeks which healthcare providers can recommend.[4]

  • Counsel on the signs of infection

With chronic wounds, there’s no precise timetable for healing. Each patient is unique, and how quickly and efficiently a person’s body recovers from a chronic wound can depend on several factors, ranging from the type and size of the wound to their overall health and nutrition status.

In general, the larger the wound, the longer the recovery process will be. For these patients, enlisting a caregiver for support can be a helpful strategy to make the recovery process easier.

  • When to ask for help

Throughout healing, it’s essential that patients learn how to recognize the signs of a wound that is getting worse instead of better – and when it’s time to seek additional care. These can include,

      • increased levels of pain and discomfort
      • redness
      • pus, or discharge from the wound site, 
      • sensitivity 
      • swelling
      • a noticeable odor[5]

Remind patients and caregivers to call immediately if they experience any of these symptoms, to ensure the infection is caught and addressed early.

Related Content:  What You Need to Know About MRSA and What to Do About It

Support patients during the age of COVID

It’s difficult to predict what the coming months will bring as the COVID-19 pandemic continues. We must recognize that individuals with chronic wounds may feel particularly vulnerable while navigating the healthcare system with its heightened health and safety measures.

This presents healthcare providers with an opportunity to engage with these patients in new ways. From reviewing the best methods for at-home wound care to discussing lifestyle changes and recommending helpful nutrition supplements.

These are simple steps that can go a long way in offering patients and their caregivers the proactive means to take control of their health.

Expanding the channels of support to include telehealth and virtual platforms could also be a valuable way to provide reassurance and emphasize the appropriate steps for at-home care. It also helps avoid unnecessary visits to doctors’ offices, hospitals, or other care facilities for the time being, as appropriate.

Related content: Doximity’s New Telehealth Platform Makes it Easy to Connect

The bottom line

The best way to ensure effective self-care, monitor wound healing, and answer questions as they arise is by scheduling regular check-ins. This allows clinicians to maintain an accessible and open dialogue with patients and caregivers as they deal with a chronic wound.

References:

[1] Sen CK, Gordillo GM, Roy S, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17(6):763-771. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1524-475X.2009.00543.x

[2] Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3):219-229.  https://journals.sagepub.com/doi/abs/10.1177/0022034509359125

[3] InformedHealth.org. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006. What are the treatment options for chronic wounds? 2006 Oct 17 [Updated 2018 Jun 14].  https://www.informedhealth.org/what-are-the-treatment-options-for-chronic-wounds.2706.en.html?part=behandlung-ko

[4] Williams JZ, et al. Ann Surg. 2002; 236:369-374.3 Jones, et all, Surgical Infections, 2014. https://journals.lww.com/annalsofsurgery/Abstract/2002/09000/Effect_of_a_Specialized_Amino_Acid_Mixture_on.13.aspx

Jones, et al., Surgical Infections, 2014;15(6):708-712.): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268587/

[5] Frank C, Bayoumi I, Westendorp C. Approach to infected skin ulcers. Can Fam Physician. 2005;51(10):1352-1359https://www.cfp.ca/content/51/10/1352 

 

What if you could age slower and maintain your ability to be active and enjoy your family well into your 70’s or 80’s or beyond? What if you could delay the onset of chronic disease by almost a decade? Well, that is no longer a dream. Thanks to advances in the science of aging and chronic disease, we know that there are things that you can do now to impact your health and, perhaps, your longevity.

Let’s start our discussion by diving into some of the basic science related to prolongation of a healthy lifespan. Don’t worry, we are going to start with a video and it’s going to be fun.

What we can learn about aging and longevity from worms

First, check out this very entertaining short TED talk by Cynthia Kenyon who is a top scientist at the University of California at San Francisco Medical School. Then come back to this post for an expanded discussion. 

The importance of Dr. Kenyon’s work and that of contemporary aging researchers is that they showed, for the first time, that aging and age-related chronic diseases aren’t things that “just happen” to us. [1] They are, in fact, related to an evolutionarily-conserved complex, highly regulated, and interconnected series of biochemical pathways.

Central to these pathways is a molecule called mTOR which stands for mechanistic Target of Rapamycin. It is so-named because rapamycin, a naturally occurring substance, inhibits the many of the activities of mTOR triggering a variety of metabolic and clinical outcomes. The most well-known of which is the extension of healthy lifespan.[2, 3]

mTOR: The master regulator of cell metabolism

mTOR exists as a complex of proteins called mTOR complex or mTORC. There are actually two different forms mTORC known as mTORC1 and mTORC2. Activation of the complexes occurs via different pathways. Once activated the mTOR complexes, in turn, activate or inhibit pathways critical to cell function. [2, 3]

mTORC1 and 2 are activated or inactivated depending on the availability of nutrients and certain other substances in the cell’s environment (e.g., glucose, amino acids, and various growth factors). In fact, you can think of mTORC as integrating and responding to the energy status of the cell’s environment.

  • mTORC1

When times are good and energy, oxygen, nutrients, and growth factors is plentiful, mTORC1 is activated and stimulates metabolic pathways that lead to growth. When times are tough, those pathways are suppressed and the pathways related to survival are activated.

Here are some of the cellular functions mTORC1 regulates [2,4]:

      • Mitochondrial biogenesis (building new mitochondria, organelles that generate energy)
      • Nucleotide biosynthesis (nucleotides are the building blocks of RNA and DNA)
      • Protein synthesis (creating new proteins)
      • Lipid biosynthesis (generation of lipids from precursors)
      •  mRNA translation (decoding the genome on the way to creating new proteins)
      • Autophagy (cleaning out damaged or unnecessary cellular organelles. This frees up components to create new ones. 
      • Lysosome biogenesis (creation of organelles involved in breakdown and waste removal in the cell. Lysosomes have been called the stomach of the cell.

The last two functions are inhibited when energy, nutrients, and growth factors are plentiful.

  • mTORC2

mTORC2 is activated by insulin and growth factors. [2,4] It regulates the following:

      • Cell proliferation
      • Cell survival
      • Apoptosis (cell death)
      • Cell metabolism
      • Cytoskeleton organization (maintaining cellular infrastructure)
  • Rapamycin

Rapamycin inhibits most but not all of the activities of mTORC1. However, it does not inhibit mTORC2 in the short run. There is some evidence that chronic administration of rapamycin, however, can inhibit mTORC2.[4] Further, there are important feedback pathways between mTORC1 and mTORC2.

mTOR acts as a nutrient sensor linking availability to various cell functions

Living organisms on our planet are subject to varying availability of nutrients and other sources of energy. In order to survive, they must be able to sample the energy availability in their surroundings and adjust accordingly. 

mTOR-linked pathways provide that mechanism. Receptors found in cell membranes have both an external-facing component and an internal-facing component. The external component binds to nutrients, such as glucose, amino acids, oxygen, and various growth factors. As described above, this leads to the activation or inactivation of different intermediate proteins that ultimately activate or inhibit mTOR.

For example, during times of energetic stress, a protein known as AMPK is activated. This in turn inhibits mTORC1 and leads to activation or inhibition of other intermediate compounds. The result is a state of cellular activity that favors prolongation of lifespan.[5] 

Although the pathways are incompletely understood, it is of note that dietary restriction – a self-induced famine in a way – is also associated with longevity.[5] We must remember, though, because of complex feedback loops, the ability to prolong lifespan via these mechanisms is not limitless. 

On the other hand, during times of plenty, the availability of glucose increases. In addition to reducing the activation of AMPK, it also triggers the release of the hormone insulin and insulin-like growth factor). This leads to mTOR activation and the creation of a state that favors growth and development. Unfortunately, it can also lead to amongst other things, elevated lipid levels that favor the development of chronic diseases.

Practical applications of this complex molecular biology

  • Carbohydrate restriction

Understanding the molecular biology of the mTOR pathways has some very practical applications. For example, as we have already pointed out, restricting calories is associated with reduced levels of some factors that inhibit mTORC1. This, then, is associated with lifespan extension.[5]  Intermittent fasting [6] and exercise [7] also reduce mTOR activity. 

Also, restricting carbohydrates in people with Type 2 diabetes is known to lower blood glucose, insulin, and IGF-1 levels. The benefits of this type of diet do not require weight loss, although many do lose weight with carbohydrate restriction. In fact, some experts have called for dietary carbohydrate restriction to be the first intervention prescribed in Type 2 diabetes management.[8]

The prevailing American high-carbohydrate, high-fat fast-food diet, on the other hand, drives extra calorie intake and as well as higher levels of the factors that activate mTORC1. This, unfortunately, leads to metabolic conditions that accelerate the development of chronic diseases such as diabetes and heart artery problems.[9]

  • Metformin

Metformin is the most commonly prescribed drug for Type 2 diabetes. Multiple mechanisms of action, both direct and indirect have been proposed for this drug, including microbiome modification.[10]

However, it has also been shown to interfere with the same signaling pathways that we have been discussing. Specifically, it leads to the reduction of glucose, IGF-1, insulin levels, and the inhibition of mTORC1. [11]

This results in a metabolic state that favors important health outcomes, including the following:

Further, the drug has been proven to be safe with relatively few serious side effects. And, it is cheap, making it accessible even for people without health insurance.

Metformin is the also first drug approved by the FDA to enter a clinical trial to assess its effect on prolongation of a healthy lifespan. According to American Association for Aging Research, the Targeting Aging with Metformin (TAME) trials are a “series of nationwide, six-year clinical trials at 14 leading research institutions across the country that will engage over 3,000 individuals between the ages of 65-79.”

These trials will test whether those taking metformin experience delayed development or progression of age-related chronic diseases—such as heart disease, cancer, and dementia.

  • Rapamycin and rapalogs

As mentioned, the drug rapamycin inhibits mTORC1 activity and is associated with a prolonged lifespan. However, systemic rapamycin has unacceptable side effects, so its use is limited in humans.

It is used, however, for local applications. One example is the use of Sirolimus (the brand name of rapamycin) in early versions of drug-eluting stents (DES) used to treat coronary artery disease. [13]

More recently, scientists have modified rapamycin to create less toxic forms of the drug. They are known as rapalogs. These include everolimus, zotarolimus, and biolimus. Together with improved stent platform materials, the use of these DESs has been shown to lower thrombotic events related to the stents. [14]

Preventing chronic disease

There are a number of drugs that are used for cardiovascular disease that specifically impact the mTORC pathways by various mechanisms. For example, lisinopril (an ACE inhibitor), losartan, an angiotensin receptor blocker [15], atorvastatin, a statin [16], and eplerenone [17], a mineralocorticoid receptor blocker, all reduce oxidative particle formation. Indirectly, this leads to the inhibition of mTORC. [18]

This, as we know, leads to metabolic changes that favor healthy aging. These effects on the mTOR-related signaling pathways may be the reason why these medications lower the risk of heart attack and stroke more than they reduce the target risk factors of blood pressure, lipid, and glucose levels.

Interfering with this core signaling is a form of precision medicine that impacts the molecular biology that causes cardiovascular disease, cancer, and accelerated aging. These medications are antioxidants that work.

The language of life

Here is the most shocking insight. The same core signaling that causes accelerated aging, chronic disease, and ultimately death is essential to produce a perfectly developed newborn. At the moment of conception, there is a single cell that will ultimately become all the cells in the body with their vastly different functions.

The DNA for every cell in your body is the same. Epigenetic regulation determines which genes are turned on or off in a particular cell type. For example, normal EGFR function is necessary to establish pregnancy [19][successfully at the very beginning of life. However, it contributes to chronic disease development later in life.

Angiotensin II is required to form a normal fetal kidney [20], but inappropriate activation later in life contributes to developing hypertension, chronic kidney disease, and congestive heart failure.

mTOR activation via nutrient sensing and growth factor signaling in the fetus directs a master symphony [21] of switching genes on in just the right place, at just the right time, with just the right intensity for an exact amount of time to produce a perfect infant.

However, the same genes that are essential to coordinate normal development cause disease and death with chaotic activation later.

Summary

The human genome project did not give us the answers for accelerated aging and common chronic diseases. These problems are caused by normal genes that are inappropriately switched on later in life by things like aging, unhealthy diets, and tobacco smoke.

Specific highly effective generic medications with few side effects can block the signaling from those genes and lead to dramatically better clinical outcomes at a lower cost. Caloric restriction, intermittent fasting, exercise, and the specific medications mentioned all impact the same signaling pathways.

In order to fully unlock the potential of primary care, we need to move from management of risk factors (e.g., blood pressure, glucose levels) to manipulations of the metabolic pathways that are at the heart of many chronic diseases. We believe that “metabolic medicine” is the key to a healthier future 

References:


  1. Kenyon C. The first long-lived mutants: discovery of the insulin/IGF-1 pathway for ageing. Philosophical Transactions of the Royal Society B. (2011) 366, 9-16.
    https://royalsocietypublishing.org/doi/10.1098/rstb.2010.0276

2. Papadopoli D, Boulay K, Kazak L, et al. mTOR as a central regulator of lifespan and aging [version 1; peer-review: 3 approved] latest versions as of 07/27/20.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611156/pdf/f1000research-8-18802.pdf

3.  Weichhart T. mTOR as a regulator of lifespan, aging, and cellular senescence. Gerontology. (2018) 64(2):127-134.  https://pubmed.ncbi.nlm.nih.gov/29190625/

4. Samidurai A, Kukreja R, Das A. Emerging role of mTOR signaling-related miRNAs in cardiovascular diseases. Oxidative Medicine and Cellular Longevity. Volume 2018, Article II6141902, 23 pages      https://www.hindawi.com/journals/omcl/2018/6141902/              

5.  Longo V, Antebi A, Bartke A, et al. Interventions to Slow Aging in Humans: Are We Ready? Aging Cell (2015) 14, 497-510.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531065/

6.  de Cabo R, Mattson M. Effects of intermittent fasting on health, aging, and disease. NEJM (2019) 381:2541-2551. https://www.nejm.org/doi/full/10.1056/NEJMra1905136

7. Dreyer H, Fujita S, Cadenas J, et al. Resistance exercise increases AMPK and reduces 4E-BP1 phosphorylation and protein synthesis in human skeletal muscle. J Physiol (2006) 576:2, 613-624. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1890364/

8.  Feinman R, Pogozelski W, Astrup, A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition (2015) 31:1-13. https://www.sciencedirect.com/science/article/pii/S0899900714003323

9. Samidurai A, Kulreja R, Das A. Emerging Role of mTOR Signaling-Related miRNAs in Cardiovascular Diseases. Oxidative Medicine and Cellular Longevity (2018) Article ID 6141902. https://www.hindawi.com/journals/omcl/2018/6141902/

10. Rena G, Hardie D, Pearson E. The mechanisms of action of metformin. Diabetologia (2017) 60(9):1577-1585. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552828/

11. Amin S, Lux A, O’Callaghan F. The journey of metformin from glycaemic control to mTOR inhibition and the suppression of tumor growth. Br. J. Clin Pharmacol (2019) Jan, 85(1):37-46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303203/

12.  Kasznicki J, Sliwinska A, Drzewoski J. Metformin in cancer prevention and therapy. Ann Trans Med (2014) June;2(6):57 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200668/

13. Serruys P, Regar E, Carter A. Rapamycin eluting stent: the onset of a new era in interventional cardiology. Heart (2002) 87:305-305. https://www.researchgate.net/publication/277539488_Rapamycin_eluting_stent_the_onset_of_a_new_era_in_interventional_cardiology

14. Im E, Hong, M-K. Drug-eluting stents to prevent stent thrombosis and restenosis. Expert Rev Cardiovasc Ther (2016) 14(1):87-104  https://pubmed.ncbi.nlm.nih.gov/26567863/ 

15. Ding G, Zhang A, Huang S et al. ANG II induces c-Jun NH2-terminal kinase activation and proliferation of human mesangial cells via redox-sensitive transactivation of the EGFR. AM J Physiology Renal Physiol (2007) 293:F1889-G1897 https://journals.physiology.org/doi/pdf/10.1152/ajprenal.00112.2007

16. Tanaka S, Fukumoto Y, Minami T. et al. Statins exert the pleiotropic effects through small GTP-binding protein dissociation stimulator upregulation with a resultant Rac1 degradation. Arterioscler Thromb Vasc Biol (2013) July;33(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863549/pdf/nihms-536909.pdf

17. Huang S, Zhang A, Ding G et al. Aldosterone-induced mesangial cell proliferation is mediated by EGF receptor transactivation. Am J Physiol Renal Physiol (2009) 296: F1323-F1333 https://journals.physiology.org/doi/pdf/10.1152/ajprenal.90428.2008

18. Blagosklonny M. From rapalogs to anti-aging formula. Oncotarget (2017) 8(22) 35492-35507. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482593/pdf/oncotarget-08-35492.pdf

19.  Large M, Wetendorf M, Lanz R et al. The Epidermal Growth Factor Receptor Critically Regulates Endometrial Function during Early Pregnancy. PLoS Genet (2014) 10(6):e1004451 https://doi.org/10.1371/journal.pgen.1004451

20. Gubler M, Antignac C. Renin-angiotensin system in kidney development: renal tubular dysgenesis. Kidney (2010) International 77(5): 400-406. https://www.sciencedirect.com/science/article/pii/S0085253815542646

21. Hennig M, Fiedler S, Jux C et al. Prenatal Mechanistic Target of Rapamycin Complex 1 (mTORC1) Inhibition by Rapamycin Treatment of Pregnant Mice Causes Intrauterin Growth Restriction and Alters Postnatal Cardiac Growth, Morphology, and Function. J Am Heart Assoc (2017) 6:e005506. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586418/pdf/JAH3-6-e005506.pdf


Reviewed and updated with new references on 8/14/20.


Other articles in this series:

Healthy Life Extended by Eight Years in a Landmark Study

Heart Attacks: When Will We Finally Do What Needs to Be Done

Is There Really a Way to Reverse Diabetes?

A Unifying Hypothesis of Chronic Disease and Aging

Erectile Dysfunction: Is It a Sign of Heart Disease?

Why We Need to Unlock the Full Potential of Primary Care

Reshaping Healthcare: What We Can Learn From Alaska

 

We are living longer and longer. As our lifespans extend to 80, 90, 100 years or more, having a good quality of life during those years becomes increasingly important. How can we stay healthy? And, how can we still do the things we want to do? Finally, how can we feel content and fulfilled until the last moments of our lives? Here are my 8 life-changing tips that will help you age well.

How to age well

The keys to aging well with health, happiness, and peace lie in training our-

      • physical power
      • heart power
      • brain power
  • Physical power

Physical power is a cornerstone of happiness and health. Having enough muscle mass, flexibility, bone density, immune response, cardiac tone, and more, all contribute to being able to do the things that make us happy. It also contributes to having confidence and a positive outlook on the future.

  • Heart power

Heart power is the ability to follow our conscience and have tolerant compassionate relationships. Like physical power, the more we use our heart power, the greater it grows.

Close personal relationships, such as those with family and friends and the communities to which we belong, are excellent training grounds for heart power. Having a social support network built on heart power remains one of the cornerstones of healthy aging, according to studies in areas with a high population of centenarians.

  • Brainpower

Brainpower is creativity. That is the ability to use our insight and wisdom to create something that contributes to ourselves and to the world.

Creativity comes from curiosity, from an interest in and love for ourselves and our surroundings. Being engaged in the world and trying new things stifles cognitive decline. It also provides a sense of excitement for living. It leads to creation and contribution to others that gives us fulfillment and a reason to live.

Building our physical power, heart power, and brainpower can be done with simple changes in our lifestyle and outlook that add up to a big difference.

ADD_THIS_TEXT
 

Here are eight ways to do it from my recent book, I’ve Decided to Live 120 Years.

1. Get up and move

Staying physically active is essential for developing physical power. However, hectic lives and inertia often get in the way of our staying as active as we need to.

However, exercise doesn’t need to take a lot of time or involve special equipment or clothing to be effective. Recent research has indicated that short bursts of high-intensity exercise can be as effective as longer bouts.

Try exercising for just one minute every hour. If you can, do a strong, high-intensity exercise such as push-ups, plank, sit-ups, or jumping jacks.

But if you cannot, try a gentler exercise such as stretching or breathing. Choose exercises that work for you and make you happy. You can even use exercises from practices like yoga, tai chi, or qigong.

aging well seniors doing Tai Chi graphic

The practice of Tai Chi has an added benefit – it helps to improve your balance. (Graphic source: Stock)

By scheduling your exercise in short bursts throughout the day, you break up the length of time you spend sedentary. Longer periods of uninterrupted sitting is a risk factor for disease and decline.

Related content: Fall Prevention: Why Every Aging Adult Should Learn Tai Chi

Try to fit in one minute at least ten times a day. I believe that mindfully exercising for just one minute every hour will keep your body and mind alert, strong, and flexible.

2. Dream up goals and work to achieve them

Dreams and goals fuel your body and mind to move. They motivate you to take care of yourself, grow, and change. No matter how old you are, continue to develop yourself.

Rather than living day-to-day, without something meaningful to work toward, focus on goals that are near and dear to your heart. You will find yourself waking up with excitement each morning, eager to see what lies ahead.

3. Look forward to aging with anticipation

A good attitude is another important part of living a long, healthy life. Change your attitude about getting older, if you have any negative assumptions.

In studies on attitudes toward aging, those with negative attitudes tended to walk more slowly and have worse cognitive abilities than those who had a more positive outlook.

Rather than seeing the wrinkles, stooped posture, or old-fashioned notions, remember all the wisdom and experience you accumulate and can share with others. You can live with hope and dignity at every age.

4. Give back to age well

Sharing and giving are the greatest rewards we can receive. Developing a habit of helping others or contributing to your community forges the social connections aging experts say are important for aging well.

In caring for others, you are more motivated to care for yourself. You might mentor a young one, give money to a charity, or do something fulfilling that supports the next generation. Make sure the cause is something you believe in, and you’ll enjoy your selfless giving in ways that might surprise you.

5. Spend time in nature

Visit natural places often, wherever you may be, and whenever you get the chance. You don’t necessarily have to go to distant mountains or the wilderness, or to the ocean. A park or trail near your home is good, too. Go wherever you can feel the sunshine, trees, water, and wind, and wherever you can see the open sky and walk on unpaved ground.

Related content: What is Nature Deficit Disorder and How to Know if You Have It

Being in nature, or doing a nature meditation, helps you let go of your stress and worries. Nature rejuvenates body and soul. Treat nature like a friend and it will heal the wounds you’ve suffered and open your closed heart.

Graphic man meditating

Meditation’s many health benefits have been well documented in a number of scientific studies. (Graphic source: iStock)

6. Meditate

Meditation is a good practice for people of any age. Many studies have confirmed that it is excellent for relieving stress. It can offset some of the cognitive declines that comes with aging, by

      • improving focus
      • memory
      • creativity
      • target

Most of all, meditation makes you happier since it promotes a calm state of mind and has been shown to increase serotonin and dopamine, hormones associated with happiness and contentment.

You may also enjoy: How to Help Your Partner Make Healthy Lifestyle Changes

7. Try something new to age well

Your brain doesn’t need to grow stiff and forgetful as you age. It has the capacity to make new neural connections any time if you exercise it with new challenges.

Instead of doing the same routines day in and day out, grow your brain power by doing things that are different. It’s even better if they are difficult.

This could be learning a foreign language, taking a challenging class at your local college, or immersing yourself in an art form that’s unfamiliar to you.

Even brushing your teeth with your non-dominant hand each night can help your brain grow in wonderful ways.

8. Contemplate life’s questions

Discover your values and what your brain really wants to create by probing your inner wisdom. Sit in quiet contemplation and ask yourself:

      • Who am I?
      • And what do I want?

Ask until the answers come to you and then trust those answers. They will guide your decisions and actions for a life of fulfillment and inner peace.


This story was first published on Dec. 19, 2017. It has been reviewed and references updated for republication on Aug. 5, 2020.

Who knew that a trip to the airport, one that I had done many times, would end up so badly. Here is what happened in August 2016 when I fell and broke my shoulder.

I was in a hurry to get to the gate for my flight to Tuscon. I was flying to an important meeting where I was going to have the chance to interview a former Surgeon General. The traffic from Marin to SFO was obnoxious, and the TSA line very slow.

I was wearing a heavy backpack. Optimistic about getting some work done on the plane, I had filled it with medical journals and my laptop. I was also pulling my wheelie.

I was walking my usual fast pace when the ball of my left foot struck the floor first—it had been happening a lot lately—and I stumbled. As I tried to get my balance, the backpack slid up towards my head and propelled me forward and down—hard.

I took the brunt of the fall on my right shoulder, but the worst pain was in the middle of my upper arm. I couldn’t use it to help me get up off the floor.

After the fall

A kind passerby got down on the floor next to me and said, with confidence, “I am certified in first aid. Can I help?” Grateful, I directed her to take my left arm and gently pull me into a sitting position.

By now, I am the center of attention, surrounded by airport police, passengers, and a United Airlines representative who told me, in no uncertain terms, that I would not be getting on my flight to Tucson. This was after I asked him to please take me to the gate in a wheelchair. Although he kindly booked me on a later flight, just in case the injury turned out to be something minor, he had already called for an ambulance.

So that was how I ended up as a patient in the ER I used to work in. The emergency physician on duty was one of the few people I still knew at Kaiser South San Francisco.

He sewed up a small laceration in my right eyebrow and arranged for the x-ray. The radiologist, an old friend from my running days, gave me the bad news. I had a displaced fracture of the greater tuberosity of the humerus plus a non-displaced surgical neck fracture.

I was definitely not going to Tucson.

broke my shoulder

My Xrays showed a proximal humerus 2-part fracture. I am definitely not going to Tucson. (Photo source: author)

Why a fall is not just a fall

There are so many interesting and important questions raised by my fall that I want to share with you because I learned that a fall is not just a fall and a broken shoulder is not just a broken shoulder. Bear with me as I take you through some of my thinking.

First of all, there’s the question: Why did I fall? The folks at the airport and the clinicians in the ER asked all the right questions to make sure it wasn’t something that needed an urgent evaluation. Did I have chest pain, dizziness, palpitations? No. Did I trip on something—an uneven tile or an object on the floor? No.

I am very clear about why I fell. I tripped over my own left foot. Once I explained that people lost interest in why I fell and concentrated on the result of my fall—the proximal humeral fractures. But, we will come back to the why later on because it is one of the most important questions that can be asked about a fall.

Managing the pain of my broken shoulder

The next question was, what did I need for pain? I opted for 1 gram of IV acetaminophen. It worked like a charm and left my head clear, so I could sort out the other issues.

One of the most urgent was notifying my client that I would not be at their meeting in Tucson the next morning. I also had to figure out the best way to get home without having my husband schlepp an hour to retrieve me.

An obviously important issue to address: What’s the treatment? After all, you can’t put a shoulder in a cast.

I was given a sling and a follow-up appointment in Orthopedics for a week hence. I opted for NSAIDs for pain because I don’t like nausea and foggy head that accompany opioids. It turns out that was all I needed.

Getting discharged from the ER was smooth and easy

The discharge from the ER was amazing. My friend, the ER doc, gave me a white and blue pocket folder filled with all the information I would need until I could see the bone doc. In it were several sheets of paper that described upper extremity fractures. It also outlined the home care and follow-up instructions and explained when to seek urgent medical advice.

I also found instructions on how to take the pain medication together with a note telling me that I could pick up my prescription at any pharmacy. It was already entered into the system-wide EHR. (Eat your hearts out, all you people getting care outside of an integrated delivery system.)

I tucked the paper copies of my X-rays in the folder and paid my $5 (no kidding) copay. And then I said my thank yous to the staff who had treated me so kindly and professionally.

ADD_THIS_TEXT
 

I took a Lyft home, whining to the driver about how I was missing a great meeting in Tucson. Even more important, I complained, I was going to miss the upcoming family trip rafting the Middle Fork of the Salmon that I had been looking forward to for months.

Follow-up for my broken shoulder

broken shoulder

My bruised arm looked like something from another world. Who knew a trip and fall could end up looking like this?

I got plugged into Kaiser’s orthopedic department and had regular x-rays to ensure healing was going ok. Of course, I spent hours on PubMed and other sites on the internet trying to determine what was the best treatment for my particular fractures.

My fellow internists won’t be surprised to hear that the Orthopedic literature is a mess. Most of the papers I read insisted surgery was the treatment of choice, but I was being treated conservatively with a sling and physical therapy (PT).

So, I made an appointment with the shoulder specialist at my Kaiser medical center to review the literature—yes, you can do that. He described several studies. One was from the UK that I had already read. The researchers found that outcomes were the same for people treated with surgery and those treated with a sling. 

This was the case even if there was displacement of the greater tuberosity like I had. Further, he pointed out, the top of my humeral head had a good shape. Also, there was plenty of room between it and the acromion, so impingement syndrome was unlikely.

I was lucky. Even before I started PT, my shoulder range of motion started to improve. With PT, I went to 80% of the way to normal shoulder function within 2-3 months. I continued doing my PT exercises at home for about a year and a half. My functional range of motion is now about 95 to 100% normal.

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Many questions about my fall and fracture remain

I have only scratched the surface of issues related to falls and fractures in this post. Many questions remain:

  1. The humerus is a big bone. Why did mine break after a simple fall from a standing position? Had my long-standing osteopenia progressed to osteoporosis? If I have osteoporosis, what is the best treatment? And what are its side effects?
  2. Why did I trip? Did I have a foot drop or some other gait abnormality? Or was it just a problem with my shoes, my clumsiness, or my inattention? Equally important, what can I do to prevent falling in the future—a huge source of morbidity for women (and men) “of a certain age.”
  3. How can I get back the full and normal function of my right arm? Believe it or not, I was so good at holding it still by my side that I had to consciously remember to use it once it was freed from the sling.
  4. How do I overcome my newly acquired fear of falling and mental images of falling when I go up and down stairs or walk with my big old black lab? Is this a form of PTSD? What’s the best way to renormalize my disturbed sleep?

It is important to explore all of these aspects of falls and fractures because I think all too often clinicians, friends, and family members,—and even patients—think that a fall is just a fall. But in many cases, as I have learned, a fall may be so much more.

If you would like to add to this list of issues to explore, please pass them along either as a comment on this post or as an email to [email protected]

Learning and supporting each other

I am also hoping to hear more from readers about their experiences with osteoporotic fractures. I am pleased that the comment section of this post has become an important resource for people (mostly women) who have fallen and broken their shoulders.

In addition to telling their fracture stories, women have been offering answers to the following questions:

  • Did anyone ask if you had low bone density (osteopenia or osteoporosis)? Were you offered screening for the condition?
  • Were you evaluated for underlying or contributing reasons for the fall (e.g., balance problems, vision problems, safety issues in the home)?
  • Did you experience significant emotional sequelae (e.g., fear of falling, depression, insomnia) after the fall/fracture? Did any of your health professionals ask about or offer help with these symptoms? 

Please join in by leaving your responses in the comment section below. Or, send me an email via [email protected]

Related content:
Do You Know Your Risk of Fragility Fractures?
Why are So Many People Taking Their Chances with Osteoporosis?
Drugs, Falls, and Fractures: Missed Opportunities in Osteoporosis
Early Testing for Osteoporosis Gives Voice to a Silent Disease


Originally published in August 2016, it was updated by the author for republication today.

Before I dive into the scientific evidence about whether optimism and pessimism impact health outcomes, let me tell you a short story. When I was a young medical student, I had the opportunity to trail Professor John Englebert (“Bert”) Dunphy on his evening rounds. He was at that time the widely admired and beloved Chairman of the Department of Surgery at the University of California San Francisco.

The good doctor always made a point of visiting his patients the evening before their scheduled surgery. During that visit, he would engage them in a conversation about their upcoming surgery. He would also ask them about their families and their outlook on life in general.

Afterward, he would go to the nurses’ station and strike off the next morning’s list of patients those that were pessimistic about their odds of a successful procedure. I have always remembered what he told me about why he did this:

In my experience, he said, their odds of surviving a difficult procedure or post-op period are pretty slim.”

I was awe-struck, though my feelings were mixed with a healthy dose of skepticism. In those days, surgeons justified just about everything they did with the phrase, “in my experience.”

Pessimism and poor health outcomes health

Sometime later, an article by Pauline Chen, MD caught my attention. In it, she describes an episode from her medical practice. Her patient, a diabetic, had been hospitalized for a toe infection that should have responded to a simple course of IV antibiotics. But, in this case, it did not.

Instead, the patient required a series of amputations—each one higher up the foot—in an attempt to stem the infection. He began to lose weight and eventually required nutritional support. Then, one day, he died.

Before he died, Dr. Chen asked a consulting psychiatrist if her patient was depressed? “He’s not,” the consulting psychiatrist told her, “it’s just the way he is.” In other words, he was a pessimist by nature.

Now, these are interesting anecdotes, but you might be thinking, is there actually any scientific evidence that optimism or pessimism can impact health outcomes?

The scientific evidence that optimism and pessimism impact health

In fact, there is real scientific evidence that an optimistic disposition leads to better health. The converse is true for pessimism. Here are but a few findings, out of dozens of articles published on the subject over the last 20 to 25 years:

  • Optimists are twice as likely to be in ideal cardiovascular health, according to a  study led by Rosalba Hernandez, a professor of social work at the University of Illinois.
  • Optimistic individuals recover more quickly following cardiac-related events, such as coronary artery bypass surgery and myocardial infarction. They have a more rapid return to a normal lifestyle and a better-reported quality of life.
  • Edna Maria Vissoci Reiche and colleagues have found that pessimists are prone to higher levels of stress hormones, lowered immune response, and increased levels of cancer.
  • Optimism also appears to be associated with lower levels of distress, slower disease progression, and improved survival rates in patients with HIV.

More by this author: The Unfortunate Consequences of Disbelieving in Free Will

Optimism and cause-specific mortality

A more recent study by Kim et al. in the American Journal of Epidemiology examined the association between optimism and cause-specific mortality. The strength of this study is that it was prospective. It is also statistically well-powered using data from 70,021 participants in the Nurses Health Study.

Related Content:  Getting Hit By a Truck Taught Me the Power of Love

The researchers measured the participants’ optimism using a standardized instrument calls the Life Orientation Test-Revised. They then divided the study population into four groups based on their degree of optimism, from lowest to highest. 

Related content: Positive Psychiatry: What is It and Why We Need It

The least optimistic group was assigned a hazard ratio (HR) of 1.0. It served as the comparison group for the other more optimistic groups. An HR of less than 1 indicates that a group is less likely to have “an event” compared to the least optimistic group. In this study, the events were a type of medical condition, such as heart disease or stroke.

Here are the HRs they found when comparing the most optimistic quartile to the least for mortality from different conditions:

  • heart disease = 0.62
  • stroke = 0.61
  • respiratory disease = 0.63
  • infection = 0.48
  • all cancers  = 0.84

This suggests a strong association between high optimism and lower mortality from these different diseases. The researchers constructed various models to test whether the association was due to confounding variables, such as sociodemographic factors, depression, and prior illness. Although in some cases the strength of the association was reduced, it was not eliminated.

Optimism and longevity

The good news is that there are numerous studies showing that optimists live longer. Here are a sampling of studies from a variety of well-respected researchers and institutions:

  • Giltay’s Delft study

In another study, a team led by Erik Giltay, MD, Ph.D., of Psychiatric Center GGZ Delfland, Delft, the Netherlands, interviewed ~1,000 men and women (ages 65-85) about health, self-respect, morale, optimism, contacts, and relationships.

They included two key questions regarding optimism:

        • Do you often feel like life is full of promise
        • Do you still have many goals to strive for? 

Answering yes to these questions revealed a sense of optimism.

During the nine-year follow-up period, Dr. Giltay and his colleagues found that those participants who reported higher levels of optimism were 55% less likely to die from any cause and 23% less likely to die from a heart-related illness as compared to the pessimistic group.

  • Hilary Tindle of the University of Pittsburgh

Another study, led by Dr. Hilary Tindle of the University of Pittsburgh, found similar results. The researchers used data from the Women’s Health Initiative, an ongoing government study of more than 100,000 women over age 50 that began in 1994. Participants completed a standard questionnaire that measured optimistic tendencies based on their responses to statements like, “In uncertain times, I expect the worst.”

Their results showed that eight years into the study, women who scored the highest in optimism were 14% more likely to be alive than those with the lowest, most pessimistic scores. The pessimists were more likely to have died from any cause, including heart disease and cancer.

Drilling down, they found that pessimistic black women were 33% more likely to have died after eight years than optimistic black women, whereas white pessimists were only 13% more likely to have died than their optimistic counterparts.

As Dr. Tindle notes, pessimistic women tended to agree with statements like, “I’ve often had to take orders from someone who didn’t know as much as I did” or “It’s safest to trust nobody.” She accounted for confounding factors such as income, education, health behaviors like controlling blood pressure, degree of physical activity, drinking, and smoking and still found that optimists had a decreased risk of death compared to pessimists.

Cynical hostility 

It is noteworthy that the title of Tindle’s article described above is revealing: “Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative.” In her study, counter to optimism is not just pessimism, rather, it is cynical hostility.

In other words, the class of “non-optimists” is not limited to the woe-is-me individual. It includes people who may feel optimistic about their own prospects, but are cynical and hostile to others.

So, the underlying factors that govern our health and longevity are not merely cheerfulness versus moroseness, they are also

        • positive versus negative attitudes,
        • compassion versus hostility,
        • love versus hate.

Dr. Tindle expands on this profound, and uplifting theme in her aptly named book: “Up: How Positive Outlook Can Transform Our Health and Aging. I highly recommend it.

  • Eric Kim’s groups at Rockefeller University

A recent study from the Rockefeller University, published in 2019, looked at the effect of optimism on longevity. According to the authors, their results “suggest that optimism is specifically related to 11 to 15% longer life span, on average.” 

They also found optimistic people have greater odds of achieving what they call “exceptional longevity”  – living to the age of 85 or beyond.

These relationships were independent of socioeconomic status, health conditions, depression, social integration, and health behaviors (e.g., smoking, diet, and alcohol use). 

Limitations of the studies

It is important to point out that these studies are all association studies. They have not been designed to prove that it was optimism that caused the better outcomes. It could be that optimistic people are more likely to have a healthier lifestyle, including eating better diets, avoidance of drugs or excessive alcohol, and exercising more. Determining cause and effect requires a randomized, controlled study design.

The bottom line

There is a substantial body of literature that strongly suggests an association between one’s outlook on life and one’s health outcomes, including longevity. Although, as we always say in medicine, definitive proof requires that we do more better studies.

That being said, there are no downsides to learning to be more optimistic. I suggest you try it – you just might like the results.


First published on 03/23/15. Reviewed and updated by the author on 07/07/2017 and again on 5/9/2020.

Getting older is inevitable and aging is often accompanied by changes in vision. As people get older, many of them struggle with cataracts:

  • Words in books may become blurred,
  • It may be difficult to focus on a computer screen.
  • Oncoming car headlights may become more bothersome.

This is because the clear lens in our eyes can become cloudy (referred to as a cataract).

Cataracts blur our vision as we age. Seniors with cataracts are more likely to suffer from trips, falls, and even motor vehicle accidents.

Cataracts increase the risk of falls in seniors

If not treated properly, cataracts can be blinding. In fact, cataracts are one of the leading causes of blindness worldwide,[mfn]https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment.[/mfn]. [mfn ][PubMed][/mfn] My mom, Susan (73), was one of them.

She found that not only was it difficult to read her computer or her phone, but objects in the distance appeared fuzzy and indistinct. Like many, she first tried to fix it by wearing bifocal glasses. However, as an ophthalmologist, I knew this wouldn’t fix the root of the problem.

In fact, bifocal, trifocal, and progressive glasses can actually increase the risk of trips and falls because they reduct depth perception. They also impair edge-contrast sensitivity (the ability to distinguish subtle differences in shading) when looking down to walk. This can cause a person to misjudge their foot placement or fail to negotiate steps or raised surfaces well.[mfn] [PubMed] [Cross Ref][/mfn], [mfn][PubMed][/mfn], [mfn] [PubMed] [Cross Ref][/mfn]

Bifocals may increase the risk of falling in seniors

Falling related to bifocal glasses is a significant danger to seniors. In fact, falls are the leading cause of injury for older people. [mfn] https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/[/mfn]  They lead to more deaths in seniors than diabetes. [mfn]Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016[/mfn] I was, therefore, worried about my mother falling.

Needless to say, quality of vision is also vital for safe driving, among many other necessary day-to-day activities.

For these reasons, I encouraged my mom to consider cataract surgery. During this outpatient procedure, an ophthalmologist (eye surgeon) removes the cloudy lens and replaces it with a clear artificial intraocular lens (IOL). This helps patients see more clearly and with greater contrast. This procedure is quite routine and is one of the most commonly performed surgeries in the United States [mfn]https://nei.nih.gov/health/cataract/cataract_facts[/mfn]

There have been big advances in cataract surgery

We’ve seen big advances in cataract surgery in recent years, particularly in the types of IOLs available. Today, we can use the procedure to correct not only the cataract, but also presbyopia (losing the ability to see at near ranges) and astigmatism (an oblong eye shape that distorts images). Following cataract surgery, many patients achieve 20/20 vision without glasses, even after needing glasses or contacts for most of their lives.

Ultimately, my mom decided to undergo cataract surgery, and it was my honor to perform the procedure myself. She and I felt confident this route would not only be best for her overall health but that it would also improve her quality of life.

During surgery, I elected to insert the TECNIS Symfony® IOL (Johnson & Johnson Vision).* It had been available for about two years at the time of her surgery.

This is the first in a new class of advanced lenses called extended-depth-of-focus IOLs. They offer a seamless, continuous range of quality vision. In my professional assessment, this was the right choice for her, but every person considering surgery needs to speak with their physician to determine what is best for them.

Related posts:
Top 8 Home Safety Tips for Seniors
Poor Vision and Senior Falls: An Ophthalmologist’s Perspective

Protect and Monitor Your Vision

Following surgery, my mom was amazed by how clearly she could see and how vibrant colors now appeared. She no longer needs her glasses for most activities. She feels it has given her more independence to do the things she loves, like traveling, playing with her grandchildren, and just performing the tasks of daily life.

As her son, I take comfort in knowing that she’s seeing clearly and is safer from fall risks. I see patients like my mom every day and encourage children of older adults to talk with their parents and their ophthalmologists to address vision issues.

The bottom line

As you age, it is important to have your vision checked annually so that a doctor can monitor your visual acuity and check for the development of diseases such as cataracts, glaucoma, and macular degeneration.

Impaired vision can make driving, moving around, and reading more difficult, so please consult your optometrist or ophthalmologist who can help answer any vision questions you may have.

In-between appointments, it’s important to be aware of the following symptoms that might warrant an earlier return visit [mfn] https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-41-to-60-years-of-age[/mfn]:

  • Problems with glare, particularly while driving
  • Difficulty with or needing more light while reading or completing close-up tasks
  • Changes in how you see or distinguish colors
  • Dry eyes or reduced tear production. Women more often experience dry eyes as they age due to hormonal changes
  • Seeing “floaters” or flashes (tiny spots or shadowy images)
  • Loss of side (peripheral) vision (a symptom of glaucoma) or
  • Distorted or wavy central vision (a symptom of age-related macular degeneration)

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Resources:

If you’d like to learn more about vision, here are some important resources

References

  1. Vision Impairment and Blindness. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment.
  2. Khairallah Moncef, Kahloun Rim, et al. Invest Ophthalmol Vis Sci. 2015 Oct;56(11):6762-9. doi: 10.1167/iovs.15-17201. [PubMed]
  3. Lord SR, Dayhew J, Howland A. Multifocal glasses impair edge contrast sensitivity and depth perception and increase the risk of falls in older people.J Am Geriatr Soc. 2002;50:1760–66. doi: 10.1046/j.1532-5415.2002.50502.x. [PubMed] [Cross Ref]
  4. Johnson L, Buckley JG, Harley C, Elliott DB. Use of single-vision eyeglasses improves stepping precision and safety when elderly habitual multifocal wearers negotiate a raised surface.J Am Geriatr Soc. 2008;56:178–80. [PubMed]
  5. Johnson L, Buckley JG, Scally AJ, Elliott DB. Multifocal spectacles increase variability in toe clearance and risk of tripping in the elderly. Investigative OphthalmolVis Sci. 2007;48:1466–71. doi: 10.1167/iovs.06-0586. [PubMed] [Cross Ref]
  6. Falls Prevention Facts. National Council on Aging. Accessed on May 17th, 2018 at https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/
  7. Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016
  8. Thoughts on Cataract Surgery: 2015. Review of Opthalmology Accessed on May 17, 2018 at https://nei.nih.gov/health/cataract/cataract_facts
  9. Adult Vision 41 to 60 Years of Age. American Optometric Association. Accessed on May 9, 2018 at https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-41-to-60-years-of-age

*Financial disclosure: Dr. Chang works with Johnson & Johnson Vision to educate people on cataracts and healthy vision. TDWI did not receive payment for publishing this article.


First published 6/19/18, it has been medically reviewed and updated for republication on 5/2/20.

This isn’t really a health story and it’s is a bit of an old story (may require subscription). But it is a story about perseverance that will make you feel really, really good. And who doesn’t need that right now?

It’s the story of Cha Sa-soon, a 69-year-old widow who, at the time this was written, was living in a remote village in South Korea. She wanted to get a driver’s license but she had trouble passing the test.

In fact, she failed the written test 949 times…that is not a typo. She failed the test 949 times. Finally, on her 950th attempt, she passed. No question, Ms. Cha proves that if you want to achieve something, you can, no matter how difficult, no matter how many setbacks.

South Koreans celebrate perseverance as a national trait. In fact, according to the NY Times article, there is a phrase there, “saj eon ogi” or “knocked down four times, rising up five.”

It became popular after Hong-Su-hwan, a popular South Korean boxing champion knocked out Hector Carrasquilla to win the World Boxing Association’s super bantamweight championship in 1977 after being floored four times. Ms. Cha certainly exemplifies saj eon ogi in spades.

Ms. Cha’s background

You have to know a bit about Ms. Cha’s background to understand just how formidable the driving test was for her. She was born into a poor peasant family and didn’t get to go to school until she was 15 years old. Even then she only attended for a few years. The Times story quoted her as saying, “Father had no land and middle school was just a dream for me.”

Ms. Cha eventually got married and raised four children. Her husband died a few years before the story about her driving test was written. At that time, she made a living selling homegrown vegetables in an open-air stall.

About 10 years ago before, she decided to get a hairdresser’s license. She had to catch a 6 am bus, transfer to a train, and then catch another bus in order to attend a government-financed training program. She did that five days a week for six months. Once finished, she could not find a job as she was considered too old.

She set her sights on getting a driver’s license

In 2005, she set her sights on getting a driver’s license. Her impetus was a desire to take her grandchildren to the zoo without having to rely on the buses that were slow and ran infrequently.

The problem was that although she could read the words in the test preparation books phonetically, she could not really understand them. She ended up memorizing the questions—and their answers—without fully comprehending the meaning.

She took the test, failed, retook it, and failed again—over and over again.  Her scores inched up but still did not meet the passing grade.

You might also enjoy: Positive Psychiatry: What It Is and Why We Need It

How she finally passed

Eventually, she enrolled at the Jeonbuk Driving School where teachers, impressed with her cheerful indefatigability, patiently explained the terminology, and coached her on the tests. One of her teachers said, “It drove you crazy to teach her, but we could not get mad at her. She was always cheerful. She still had the little girl in her.”

After passing the written test, Ms. Cha had to take the driving skill and road tests. She passed them after only four failed attempts. On the day she passed, the staff of the driving school celebrated with her by cheering and hugging and giving her flowers. One remarked, “It felt like a huge burden falling off our back. We didn’t have the guts to tell her to quit because she kept showing up.”

So “Grandma” Cha Sa-soon achieved fame and a bit of fortune in her country because of her tenaciousness. Hyundai presented her with a car and she had a stint appearing in a prime-time TV commercial for the automaker.

Ms. Cha new car sajeonogi

Hyundai gave Mrs. Cha a new car in honor of getting her driver’s license Photo credit: NY Times

It is definitely a heartwarming end to a wonderful story.

More about the human spirit: Pear Pressure: A Medical Student’s Introduction to Empathy

The takeaway: Perseverance matters

Anyone who has finally accomplished a difficult to attain life-long goal knows that “showing up” is the most important thing you can do. The temptation to quit after a failure can be overwhelming especially when well-meaning family and friends tell you, “just move on to something else” or “it just wasn’t meant to be.” 

Now, however, when you are discouraged because of a failure, particularly if it is a repeat failure, remember Ms. Cha and whisper to yourself, “saj eon ogi, saj eon ogi.” 

Then pick yourself up and try, try again.

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First published 9/4/2010, it has been updated by the author for republication at a time when a feel-good story about perseverance might be just what we need right now.

The statistics about falls in older adults are eye-opening. The Center for Disease Control and Prevention (CDC)’s STEADI program make it clear that fall prevention in aging adults is critically important:

  • One in four older adults reported a fall
  • One out of five of these falls causes a serious injury (head trauma or a fracture)
  • The severity of the injuries is compounded if the senior takes certain medications, such as blood thinners.
  • More than 3 million seniors who experience non-fatal falls are treated in emergency departments each year
  • Medicare costs for fall-related injuries amount to more than $31 billion per year
  • Hospital costs account for 2/3 of the total Medicare costs
  • Finally, falls can be fatal an older adult dies from a fall every 20 minutes

Even falls that don’t result in injury can have a detrimental impact on a person’s psyche. For example, the fear of falling may result in a decrease in physical activity. This can lead to a weakened state and increase the chance of falling. In fact, falling once has been found to double the risk of falling again. 

Risk factors for falls in aging adults

With age, individuals may develop more risk factors that can lead to a fall. During the normal maturing process, people have decreased muscle strength, slow reflexes and balance reactions, and can develop a fear of falling.

Balance and gait are also impacted by neurological conditions, such as Parkinson’s disease or stroke and complications related to visual disturbances, diabetes, and unstable blood pressure.

Advanced age also often leads to an increased number of prescription medications. According to a study in the Journal of Age and Aging, people taking 4 or more prescription medications have an increased risk of falling.

Since most falls are caused by a combination of factors, the greater the number of risk factors one has, the greater the chance of falling.

Related: What Happened After I Fell and Broke My Shoulder

Fall prevention

Fall prevention, in the form of patient education, screening, assessments, exercise and physical therapy is more important than ever. But what do we know about interventions that work?

A 2010 systematic review of the evidence for the U.S. Preventive Services Task Force (USPSTF)found that exercise, physical therapy, and Vitamin D had evidence to support efficacy in fall prevention. 

The exercise examined in the USPSTF included general exercise (walking, cycling, etc.), resistance training, and “some type of gait, balance, or functional training.” They did not specifically address the effectiveness of other types of exercise, such as Tai Chi.

What is Tai Chi? 

In brief, the ancient Chinese practice of Tai Chi is a soft martial art. The name when translated approximates “supreme, ultimate harmony.” 

Tai Chi is based on the principles of yin and yang. Its ultimate purpose is to enhance life and balance. Yin represents the parasympathetic nervous system (rest and digest). Yang represents the sympathetic nervous system (fight or flight).

Tai Chi involves soft, slow movements in opposite directions (yin and yang) to increase strength and improve flexibility and concentration. It also improves balance and gait.

But does Tai Chi prevent falls

A 2017 meta-analysis (a systematic review of research papers) examined the impact of Tai Chi on the risk of falls. It was published in the Journal of the American Geriatric Society. The study found that the practice of tai chi reduced the rate of falls by 43% over the short term (less than 12 months). It also reduced the rate of injury-related falls by 50%. The studies reviewed were not felt to be high quality so more studies were recommended.

Tai Chi was also shown to be effective in reducing falls in people with Parkinson’s disease and stroke in a 2018 meta-analysis published in the journal Clinical Rehabilitation. Another 2018 meta-analysis published found that “Tai Chi exercise might have a significant impact in improving balance efficiency and reducing fall rate.” And, yet another 2018 meta-analysis found that Tai Chi “may be beneficial for stroke survivors with respect to gait ability in the short term. The authors also issued a call for better studies, specifically large, long-term randomized control trials to confirm their conclusion.

All of these studies suggest that Tai Chi can improve balance and reduce falls in aging adults. Further, the studies did not find any adverse effects of the practice. Given the benefits and non-existent risks, I believe that aging adults should take the time to learn and routinely practice the discipline of Tai Chi. 

How does it work?

To achieve balance, the following principles are employed:

  • Upright posture
  • Coordinated breathing
  • Weight shifting
  • Slow, fluid, rounded movements

The slow, smooth, and continuous movements of Tai Chi help to strengthen internal muscles that support and strengthen the spine. In addition to its physical benefits, this form of gentle resistance can calm the mind.

As noted above, it may help to reduce falls, including those related to blood pressure drops from sudden movements that lead to significant blood pressure drop. This is particularly true in those who take medication that can cause variations in blood pressure.

Tai Chi practitioners are mindful of the importance of transferring weight with each step. This assists mobility, coordination, and balance And, it places emphasis on upright and supple posture to further strengthen muscles.

That said; Tai Chi—which can best be described as a moving form of meditation—is extremely low-impact, placing minimal stress on joints and muscles.

Basic Tai Chi forms

To better illustrate this gentle practice, basic Tai Chi forms might include:

Seated Cloud Hands (minute 11:50): This seated exercise requires raised hands, followed by the right-hand scooping down and then rising to land in front of the left-hand. As the right rises in front of the left, the left-hand drops down and rests above the thigh, palm facing down. The exercise is then duplicated beginning with the left-hand.

Standing Tai Chi Circling Hands: This standing exercise starts in a neutral position holding the aforementioned pretend ball. The ball is brought inwards toward the abdomen, then up, pushed down, and away.

Seated Tai Chi Circling Hands: This seated exercise can be done with or without back support, depending on comfort. The head is lifted skyward; patients are asked to pretend they are holding a ball and to bring it into their stomach, then to bring the ball up and push it away and down. The movement is then reversed.

The bottom line

By incorporating Tai Chi into an exercise program, aging adults can take advantage of the many benefits of an ancient Chinese practice that at its core promotes strength, flexibility, and balance—both physically and psychologically. All of these are key components of any fall prevention strategy.

Related Content: NAD and Healthy Aging


First published May 15, 2017. Medically reviewed and updated 2/1/20.

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Study after study has shown that people fear vision loss more than they fear cancer, stroke, heart disease, and other serious health problems. But a new study shows that Americans are scared about an issue they know very little about. And what they don’t know is putting them at risk of vision loss, including blindness.

A survey[mfn]This survey was conducted online within the U.S. by The Harris Poll on behalf of the American Academy of Ophthalmology among 3,512 U.S. adults ages 18 and over between August 8 and 27, 2019. Data by race/ethnicity were weighted where necessary by gender, age, region, income, education, household size, marital status, employment, and specific eye conditions of interest to bring them into line with their actual proportions in the population. The data for each race/ethnicity group was then combined into a grand total to reflect the proportions of each race/ethnicity within the U.S. adult population. Propensity score weighting was also used to adjust for respondents’ propensity to be online.[/mfn] conducted by The Harris Poll shows that while 81% of adults say they are knowledgeable about eye/vision health, less than 1 in 5 (19%) were able to correctly identify the three main causes of blindness in the U.S., which are glaucoma, age-related macular degeneration (AMD) and diabetic eye disease.

Why does this matter? Because most people are also unaware of key facts that could protect them from vision loss, according to the survey. For example, only around one-third of adults (37%) know you do not always experience symptoms before you lose vision to eye diseases. And less than half (47%) are aware your brain can make it difficult to know if you are losing your vision by adapting to vision loss.

The brain adapts to vision loss 

Here are the facts: 

  • Many forms of glaucoma have no warning signs. The effect is so gradual you may lose most of your vision before you realize it.
  • Diabetic retinopathy may cause no symptoms or only mild vision problems, at first. Eventually, it can cause blindness.
  • AMD is first noticed as blurriness or difficulty seeing colors and fine detail. Symptoms usually appear suddenly and worsen rapidly.

Ophthalmologists, physicians who specialize in medical and surgical eye care, have more tools than ever before to diagnose these eye diseases earlier and to treat them better. But these advances cannot help patients whose disease is undiagnosed.

Further, ophthalmologists cannot adequately care for patients who are unaware of the seriousness of their disease. Far too often, ophthalmologists witness the consequences of patients entering our office too late to avoid severe vision loss.

In 2020, we want all Americans to have a clear vision when it comes to eye health. That starts with educating yourself about eye diseases.

Eye disease is a growing epidemic

The consequences of failing to increase awareness about eye health can be dire. Right now, the number of Americans affected by these potentially blinding eye diseases is expected to double within the next 30 years, due mainly to the aging of the population.[mfn]The Future of Vision: Forecasting the Prevalence and Cost of Vision Problems. Prevent Blindness. Retrieved December 3, 2019, from https://www.preventblindness.org/sites/default/files/national/documents/Future_of_Vision_final_0.pdf[/mfn] 

    • In 2010, approximately 2.7 million persons in the United States aged 40 and older had glaucoma. By 2050, this number is projected to increase to 5.5 million persons.
    • Diabetic retinopathy will increase to 13.2 million persons by 2050, up from 7.7 million in 2010.  
    • The population with AMD will double between 2010 and 2050, increasing from 2 million to 4.4 million.  

It’s important to note that vision loss affects more than the eyes. Vision loss is also associated with the following:

  • increased risk of falls and injuries
  • social isolation
  • depression
  • other psychological problems

All of these complications of vision loss can worsen other chronic illnesses.

Related Content:  
Why You Should Have Regular Eye Exams
The Aging Eye: How to Protect Your Vision

Dealing with a Rare Eye Disease in the Midst of a Pandemic

Eye disease doesn’t affect everyone equally

Another key finding from the Harris poll is that less than half (47%) of respondents were aware that vision loss and blindness does not affect all people equally. But your risk of developing an eye disease varies significantly by your age, ethnicity, family history, and whether you smoke. Here are some relevant facts:

  • African Americans are 6 to 8 times more likely to get glaucoma than white Americans.
  • Further, blindness from glaucoma is 6 to 8 times more common in African Americans than white Americans.
  • People with diabetes are 2 times more likely to get glaucoma than people without diabetes.
  • Asians are at an increased risk for the less common types of glaucoma: angle-closure glaucoma and normal-tension glaucoma.
  • AMD disproportionately affects whites. Nearly 90% of Americans with AMD are white. Black and Hispanic American populations each account for ~4% of AMD cases.
  • African Americans, Hispanics, American Indians, and Asian-Americans all have a higher risk of diabetes.
  • Some 45% of people with diabetes have some stage of diabetic eye disease.

Vision loss and blindness is not inevitable

The Harris poll also found that only around one-third of adults surveyed (37%) know that vision loss is not inevitable as you age. Many people think vision loss is just a normal part of aging but it doesn’t have to be. You can take many steps to reduce your risk of vision loss, including

    • Eat a healthy diet, including leafy greens such as spinach or kale
    • Maintain a healthy weight.
    • Know your family’s eye health history.
    • Wear sunglasses that block out 99% to 100% of UV-A and UV-B radiation (the sun’s rays).
    • Quit smoking or don’t start.
    • Get regular eye exams

Time for an exam?

Just because you can see well, doesn’t mean all is well. That’s why the American Academy of Ophthalmology recommends that healthy adults see an ophthalmologist or an eye care professional for a comprehensive, baseline eye exam by age 40 and have their eyes checked every year or two at age 65 or older. 

People who have other risk factors will need to be seen more frequently. People with diabetes should have a dilated eye exam every year. African Americans, age 40 and older, and people with a family history of glaucoma should have a dilated eye exam every 2 years.

If you are concerned about the cost of the exam, the Academy’s EyeCare America® program may be able to help. This program provides eye care through volunteer ophthalmologists for eligible seniors 65 and older and those at increased risk for eye disease. See if you’re eligible, visit www.aao.org/eyecareamerica.

Medicare provides an annual dilated eye exam for Medicare beneficiaries over 65 at high risk for glaucoma. Those eligible for this service are people with diabetes, family history of glaucoma, or African Americans over 50. To learn more, call 800-633-4227.

The bottom line

2020 is the year to get smart about eye health. For ophthalmologist-reviewed information about eye diseases and treatments, eye health news, and tools to locate an ophthalmologist, visit AAO.org/EyeSmart.

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References

  1. This survey was conducted online within the U.S. by The Harris Poll on behalf of the American Academy of Ophthalmology among 3,512 U.S. adults ages 18 and over between August 8 and 27, 2019. Data by race/ethnicity were weighted where necessary by gender, age, region, income, education, household size, marital status, employment, and specific eye conditions of interest to bring them into line with their actual proportions in the population. The data for each race/ethnicity group was then combined into a grand total to reflect the proportions of each race/ethnicity within the U.S. adult population. Propensity score weighting was also used to adjust for respondents’ propensity to be online.
  2. The Future of Vision: Forecasting the Prevalence and Cost of Vision Problems. Prevent Blindness. Retrieved December 3, 2019, from https://www.preventblindness.org/sites/default/files/national/documents/Future_of_Vision_final_0.pdf