Mind Over Matter: Keys to Successful Aging Optimal!

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Mind Over MatterKeys to Successful
AgingOptimal!

• Brian K. Unwin, M.D.
• Colonel, Medical Corps, US Army
• Uniformed Services University

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AMERICANS ARE LIVING LONGERA TREND THAT IS
EXPECTED TO CONTINUE
Source Arias, E. United States Life Tables,
2002. National Vital Statistics Reports vol 53,
no 6. Hyattsville, MD National Center for Health
Statistics, 2004.
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Some caveats on life expectancy
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THE NUMBER OF OLDER AMERICANS IS GROWING
Source U.S. Census Bureau. Census bureau
projects doubling of nation's population by 2100.
Press release, March 13, 2001.
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THE PROPORTION OF OLDER AMERICANS IS GROWING
Source Health, United States, 2005. Figure
2. http//www.cdc.gov/nchs/data/hus/hus05.pdf.
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HEALTH STATUS AND SPENDING BY MEDICARE
BENEFICIARIES
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The Ecology of the Older Patient(per 1000/year
aged 65 or older)
1000 persons 950 will have symptoms 400
ambulatory visits 300 ED visits 200 Hospital
admits 106 Nursing Home Admissions 46 SNF
admissions
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Cascade to Dependency
Muscle Strength Aerobic Capacity
Vasomotor Instability
Bone Density
Ventilation
Sensory Continence
Altered Thirst and Nutrition
Fragile Skin
Tendency To Urinary Incontinence









Hazards of Bed Rest and Hospitalization
Immobilized High Bed Bed Rails
Plasma Volume
Accelerated Bone Loss
Closing Volume
Sensory Deprivation Isolation
Barriers Tether Rx Diet
Immobilization Sheering Force
Diapers Tether
Dehydration
Malnutrition
Syncope
Functional Incontinence
Tube
pO2
Delirium
Aspiration
Catheter
Family Rejection
Deconditioning
Fall
Physical Restraint
Chemical Restraint
Pressure Sore
Fracture
False Label
Tardive Dyskinesia
Infection
Nursing Home
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Trajectories of Dying
Cancer
22
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Dementia Strokes Arthritis Parkinsons Hip
Fracture
Lung Heart Liver
47
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Lunney, JR, Lynn J, Hogan, C. Profiles of Older
Medicare Decedents. JAGS 501108-1112, 2002
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Fitness and Functional Status
Normal
Healthy Adults
Function
Near Frail
THRESHOLD
Poor
Frail Adults
Poor
Strength
Low
High
Low
Established Populations for Epidemiologic Studies
of the Elderly (EPESE) . J Gerontology,
199449(3)M109-15
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Complexities

• Employment
• Housing
• Education
• Gender and Race
• Poverty

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Establishing definitionsSuccessful Aging

• Successful Aging
• Absence of disease and disability
• High cognitive and physical functioning
• Active engagement with life

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Establishing definitionsOptimal Aging

• Optimal Aging
• Capacity to function across domains
• To ones satisfaction
• In spite of ones medical conditions

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Determinants to health

• Physical
• Disease
• Social environment and support system
• Physical environment

• Genetic endowment
• Individual behavioral response
• Individual biologic response
• Healthcare system

Brummel-Smith, Kenneth, Optimal Aging, Part I
Demographics and Definitions. Annals of Long Term
Care, 15(11), November 2007.
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Physical activity

• Perhaps most important activity
• Potentially more impact than smoking cessation
• Prevention or treatment strategy for diseases
• Improved function
• Greater longevity
• Reduced dependency

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Exercise (Activity) Prescription for Older
AdultsDis-fitness Cycle
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Disease

• Death from stroke and heart disease declining
• Possibly falling rates of disability
• Death from dementia rising

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Social environment and support system

• Buffer against disease
• Quality of Life
• Caregiving
• Impacts biologic functions
• Mental health
• Positive impact on survival

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Physical environment

• Universal design
• Aging in place
• Pedestrian environments
• Transportation options
• Senior centers

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Genetic endowment
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Individual biological and behavioral responses

• Smoking
• Alcohol/substance abuse
• Prescription drug misuse
• Eating habits/nutrition
• Exercise
• Head injury
• Ultraviolet light
• Noise
• Sleep
• Cognitive therapy
• Social connections
• Disappointing results to modify behavior

• Promotion of self-care abilities
• Information Therapy
• Medicare expansion of preventive services
• Immunization (Flu and Pneumococcal)
• Aspirin
• Lipid evaluations
• Diabetes screening and prevention
• Blood pressure evaluations
• Avoiding disease causing agents
• Practice preventive medicine
• Early treatment of conditions
• Avoid medical misadventures

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Healthcare system

• Practice preventive gerontology
• Attention to geriatric syndromes
• Attention to quality of care measures
• Attention to end of life care
• Attention to the medical and SOCIAL care of the
  aged